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' STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. L <br /> ice of Intent No Stdte Well No <br /> Allift Permit No or Date XO1h4r Well No ,S Of '04 i Z <br /> -� 5.1= <br /> (1) OWNER Name Occidental Chemical Co. (12) WELL LOG Total depth 12 5 ft Completed depth 1 1 0 ft <br /> lddrecs <br /> 16777 South Howland from ft to ft Formation(Describe h� color character size or rnaterLill <br /> c It% Lathrop, Ca3 if ornza ZIP 0 0 - 10 Sand <br /> (2) LOCATION OF WELL (See Instructions) 10 - 33 Clay <br /> Count, San JOa uin Ussners Well NumbCr PW2 Sand <br /> %%ell address If different from ibo%e 43 - 65 Clay <br /> Township Range Section 65 - 79 Sand <br /> Distance from cities roads railroads fences etc 79 - 8Z Cla <br /> South Of Mendes Dairy 7 - 90 San <br /> 90 - 100 nCla \ <br /> 100 - 107 d <br /> (3) TYPE OF WORK 107 - 12 <br /> New Well ® Deepening ❑ - <br /> Reconstruction ❑ - ) <br /> Reconditioning ED CemenIugon thE, bottom. <br /> } Horizontal Well ❑ V <br /> I Destruction ❑ (Describe \ - - <br /> destruction materials and pro- - <br /> cedures in Item 12) - <br /> �`' (4) PROPOSED USg- _ <br /> ❑ Domestic \ <br /> r� Irrigation <br /> Industrial \ t1 ❑ �� _ ✓/ ✓ <br /> Test Well -_ <br /> Municiel ❑ ✓ <br /> Offer <br /> WELL LOCATION SKETCH I be) <br /> IS} EQUIPMENT CRAV�,,�kCK <br /> i - <br /> Rotan 1K) Reverse ❑ e ]� Nn 6 �SIZ <br /> Cable ❑ Air ❑ \ mel of bore , <br /> l i <br /> other ❑ Buck ed from �a - <br />(7) CASING INSTALLED (S) PE T3S _ <br /> Steel Plastic ❑ n e Ty of fora on or sue o _ <br /> From D Gage or \ 2s T6 < <br /> ft f I Wall tt size _ <br /> +1 2 102 . 10 0 - <br /> +1- 102 8 1 - <br /> 10 110 8 4 _ <br />(9) WELL SEAL - <br /> Was surface sanitary seal provided? 1 es [X No ❑ If yes to depth fl <br /> Were strala sealed against pollution? Yes ❑ No L) Interval ft <br />%lethodofscaling Cement Grout Work start fT 19- Com ted ]9 <br />(10) WATER LEVELS WELL R LLER aST NTDepth of first water if known ft1 tits well lied uct n rel r ss fruc to thi <br /> Standing level after well completion ft Ix st of I y t <br /> 01) WELL TESTS sigii(d <br /> "as kelt test made? I- ❑ No ❑ 1f yes by%hoin? ( I Diller) <br /> {p if tat Pump E] Bailer ElAir lett ❑ NAME Clark W l & 1 m nt o <br /> J[h to water at start of lest It AI end of test It (P on firnralion)(T)ped or printed) <br /> isrge gal/mm after hours Water temperature Address <br /> ialanalystsmade? Yes ❑ No ❑ If yes,by whom? city Stockton, California ZIP <br /> Was electric log made Yes ❑ No ❑ If yes attach ropy!o This report License No 3 71 i b C Date of this report <br /> DWR 168(REV 12 061 IF ADDITIONAL SPACE 1S NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 06 967!9 <br />