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ORIGINAL STATE OF CALIIFORNIA Do not rill in <br /> THE RESOURCES AGENCY <br /> rile with DWR DEPARTMENT OF WATER RESOURCES No. 098328 <br /> of Intent mss, r7 r7 WATER WELL DRILLERS REPORT St \\ell No_ <br /> —I Permit No or Date.— !9—/ �0..._ 0-4- 4—390.E o 5 oesoA <br /> �,,� -� Other N%ell 10 a <br /> (—\�_ <br /> �'�rNER N ame_L Mel Kn of fora n (12) WELL LOG Tot it depth-13—Off Depth of vimpleted u e ll—I-8-Qft <br />'ddress E Hwy 120 fv)m ft to ft Formation (Describe bs ccilor character We or matenali <br /> =n� Ma I't to rA _ CA ._,__, z,p 0 - 8 TopSol l <br /> 2) LOC aTiON OF WELL (see nish notions) $ - Sand <br /> >unt, San JoaQuln ._Ottners NN ell Humber 1 - Cla <br />�e13 addreab it different from abuse 37 - 42 Sand �1\ <br /> I �t,nchip Range Sectio 42 - 1 Clay <br /> t ii.c fntii) ,ties roads rulro,id fences erc 6 ^0 2 Sa ftd <br /> `- m / Celqnr V11 92 -12 Cia 7- <br /> 12 -126,- , Sand , <br /> 12 -1 la <br /> (3) TYPE OF WORK 1 6 'f- 46 Sn <br /> Nest WelIX Deepening ❑ 146 8 Clay. , <br /> Reennstrochon ❑ 148 -1�51 Sandi <br /> Reconditioning © - -151 -1 6 Clay <br /> Horizontal \\ell 131 -172 Sand <br /> Destruction ❑ (Describe 172 - -160 Clay <br /> destruchon materials and <br /> procedures in Item 12) - <br /> (4) PROPOSED USE - <br /> Domestic Yl <br /> Irrigation ❑ - <br /> Industria] 0 - <br /> Test Well ❑ _ <br /> Stmk �I - <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ - — <br /> 3) EQUIPMENT (B) GRAVEL PACK Woodland - <br /> totan ❑ He%erse ❑ Yes X No ❑ S,zeSand -. <br /> sl <br /> ihle FlAir [] Diameter of bore 1 n - <br />)ther 0 Bucket ❑ Packed from 0 t.—I-8 t - <br /> r 1 CASING INSTALLED - (S) PERFORATIONS — <br /> ttcl ❑ Plastic ❑ Concrete ❑ Type of perfniation or size of screen - <br /> From To, Dia Ga J ) — <br /> ft £t(� �in Wall it\' It—, <br /> 91) WELL SEAL - <br /> V aS surflce sanitary sell prosrded> les.M No C, If yes It depth 50 ft - <br />%ere Stratt sealed against pollution" lesP No ❑ Intersai ft - <br /> iethod of sealln• Cement \\ark started July 6 19 Completed 19 <br /> 10) WATER LEVELS N'VELL DRILLERS STATE;NJENT <br />)cl)th of fiat uatcr, if kno,in ft Thu wcll teas drilled under my nenadiction and thin report r% true to the best of my <br /> rnndmg level after sell t.omplet,on 13 —ft l.nowledgr and belief , <br /> 11) WELL TESTS SIGNED �) h %tel l d E l? ,x�f l C <br /> l )s Well test v,adr� lis ❑ 1n�`, If Yes by sshum' (Well Driller) <br /> ,>r Eif tilt Pump ❑ Hailer ❑ Air lift ❑ NAMEHennings Bros. Drilling So..Inc._ <br />)cpth to slater at btirt of test ft _ iAt and o�njyst ft (Person firm or corpnrat,nn �Ty�V r? ) <br /> -`= i !'�� � ,ri Pea a nWjR eft A!(��tyt <br /> Jarse t aE/min after hours W aleer temperature Address 4�� 0 _ <br /> Z analysts made les ❑ No$) If yes, by "homy City Modesto. Zip <br /> 1d <br />\' citrict; m <br /> log les r-1Na7�1 If sea attach copy to is- ort License No 2 0 ISae orj'this report 7A 6M <br /> 88 IREV 7 mai IF ADDITIONAL rS,P/ rG;1r I i �,ySE NEXT CONSECUTIVELY N r � IT 4.0 Mir I ;! t <br />