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Received Dec-29-99 09 48am from 227 7600 a AQUA SCIENCE page 2 <br /> CEMTRHL DISTRICT ID 227-7000 DEC 29 '99 10 27 No 002 P 02 <br /> ORIGINAL GTATC Off'CALIFORNIA / <br /> Do not fi!I to <br /> File with DWR <br /> THE RESOURCES AGENCY XF' 1' 128632 2 8 DEPARTMENT OWATIh2 RESOURCES ryOr 6 ` <br /> 3 <br /> v K re itf Intent no ,I WATER WELL DRILLERS REPORT ante Well No <br /> Permit No or Date, - 7�r <br /> ,7 <br /> Otl>er Well Nna 5 <br /> ( 1) OWNER Nnma VENEMAN FARMS 12) WELL LOG Tutal depth--2f4t Depth of compteted wel>_25ft <br /> Addret from ft to ft Fnrmatinn (Describe by color character wise or material) <br /> C rtY Zip __ - 19- Send <br /> (2) LOCATION OF WELL (See instnictions) --19 39 Clay Shale <br /> (r>unty Owners Well Number " <br /> tl'tl1 address if dltEerent Iron, abovE 0 - 0- na <br /> q <br /> Townnh,p Range Secttn 10 111 Sand <br /> Diane a from cities roads ralantads fences etc I I 115 <br /> e - <br /> 00E SOUTH OF-NY-120- - <br /> wE n _ - <br /> IA 9 <br /> (3) TYPE OF WORKr 11+4 /9 175 <br /> New Well M Deepening ❑ 17 <br /> Sand. <br /> Aecruutrucitnn © 1 - 0 L <br /> Reconditioning ❑ <190 - 115 S <br /> Horizontal Well O <br /> Dastruction ❑ (M"ribe 15 xl�qnd <br /> destruction twoorrals <br /> procedures Iitem 1 - a l f, <br /> (4) PROPOSED Fl 232 ri, <br /> Sand11 <br /> Domestic l 243 7 a ,' <br /> Jrrigatma/� an ^r\\ <br /> Industrial \ ❑ +, 1 Y <br /> Teat Well - <br /> 4 i <br /> stock\\ <br /> WELL LOCATION SKETCH Other \ Q - <br /> (5) E4u1PMENTt (B) GRAVHi,,PACK, <br /> R011kry Re� Ye441p No Q Size , 161 F Q " <br /> Cable 0 Ali 0 \ later of bore It - <br /> Other 0 Bucket ❑ .Rom Q - <br /> (7) CASING INSTALLED r (8) ERFOAATfFiN - <br /> StealX3 Plastfc ❑ C c \� Type of pe erlt-' n or4se of tcreal =From To D!a r F �) To - <br /> ft ft In wall ft s v - <br /> 0 2 t - <br /> (9) WELL SEALS V V r� - <br /> Was surfaco sanitary seri provided? ler Pio [3 If yes w depth-50 .ft <br /> were strata sealed agalml pollutlnn? Yes 0 No ❑ Interval - - -it ^ <br /> Method of sealln Work start Com tot 18 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water, if known ft rh(s well urai drilled soder my lurisdieftnn ant! this report is trite to the Bert of my <br /> Standing letel after well com lotion,_. it knowledge and heRel <br /> (11) WELL T$STSr / SIGVED o vYt ^ �f <br /> wall well telt mader Yes C] No Qf It yes, by whom t (Wotl Drlttar) <br /> Type nE test AQP [] Bailer{] Air lift C) NAME <br /> HENXTNGLq <br /> Depth to water a s 7`b [jib /a At end of test ft (Person firm or rnrparation) (TYped or prlrtted) <br /> r)bd,arge i j oyer Water t,,,"rrtture Addrets <br /> )al rcalysls ? Y(n No, <br /> Y whom? City Moyle stb, Ca zi <br /> tin „ elecirkc log made? 4.6 r (Pie, ,1E mach Cyr to this report License No Date of this repo <br /> DWR taa (REV 11r{aeaT�( ADDITIONAL SPACE 13 NEEDED USE NEXT CONSECUTIVELY NUMBERIMD FORM <br /> �''15��1► f111 <br />