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5rATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY .Do not fill in <br /> File with DWR D ARTMENT OF WATER RESOURCES _ <br /> WA R WELL DRILLERS REPORT N0. iL _ <br /> rice of Intent No State Well No <br /> Permit No or Date _ Ott�her Well No <br /> (1) OWNER Name Occidental Chemical Co. (12) WELL LOG Total depth �� It Completed depth 45 f1 <br /> Address 16777 South Howland from ft to ft Formation{Describe bs color character size or matertalI <br /> Olt,, Lathrop, California 9533 0 10 San <br /> (2) LOCATION OF WELL (See Instructions) 10 - 33 Clay <br /> County San _Joaauln OwnersWell Number PW2 4 Sand <br /> 1A'ell address if different from above 43 — Clay <br /> Township Range Section <br /> Distance from cities roads railroads fences etc — <br /> South of Mendes Dairy Cement Plug on the <br /> (3) TYPE OF WORK ldns— <br /> New Well K) Deepening ❑ — <br /> I Reconstruction ❑ <br /> Reconditioning ❑ f ^ <br /> \ Horizontal Well ❑ \ <br /> Destruction ❑ (Describe ` <br /> destruction materials and pro- <br /> _ <br /> cedures in Item 12) \ <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial / ^ Li _ <br /> Test Well \ [] <br /> Mumci�l`\ ❑ ✓ - <br /> �ier ` —_ <br /> WELL LOCATION SKETCH <br /> (5) EQUIPMENT GRAVtL ACK <br /> Rotary LX Reverse ❑ ` No Size21 <br /> Cable ❑ Air ❑ met of bore <br /> l \� <br /> Other ❑ t3uc�i.—._(] �a ed from 0 <br /> (7) CASING INSTALLED (8) PERF0,13,ATI <br /> OS _ <br /> Steel [21 Plastic ❑ n e Ty ofo on or size of r <br /> C <br /> From D� Gage or ��� <br /> ft .1 f WallJ ft `� - size — <br /> +1 12 0 u,.. <br /> 8 11 <br /> 42 4 6 8 -4 <br /> (9) WELL SEAL - <br /> WassurfacesanitarysealprovidedP Yes No ❑ If yes,to depth 37 It — <br /> Werestratasealedagniristpnllution? Yes ❑ No q lnter%al ft <br /> Method of sealing Cement Grout Worl star 19 c,,,pl,^ tianu 19 <br /> (10) WATER LEVELS WELL ILLER S T ENT <br /> Depth of first water if known It <br /> u I t i! ndc epori true fa the <br /> I� dtcli a h <br /> Standing level after writ rnmpletton ft This Ix-54 v my io a !te <br /> (I1) WELL TESTS <br /> 'uas well test=&94tgned <br /> yes ❑ No ❑ If vis by whom? (Wel nl r) <br /> �nftest Pump 13Bailer ❑ Airhfl E3NAME <br /> 1i to water at start of test II AI end of test ft n irm or mr ratio ) or pnn ) <br />®rge gal/min after hours Watertemperattire Address 2024 East Chartera)anal analysis , Stockton, California <br /> Y Yes ❑ No ❑ If yes,by whom City ZIP 95205 <br /> Was electric log made Yes C1No ElIf yes,attach copy to this report License No �?1 _ Dale of this report <br /> DWR lab iREV 12 eat IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM gb�ss <br />