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3RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> lEe with DWR DEPARTMENT OF WATER RESOURCES No. 072876 <br /> _ter of Intent No WATER WELL DRILLERS REPORT <br /> tithe 'A ell No <br /> aenmt No or D ite Other M 01 NnirL!_S in(p;-: 3 5 <br /> VVNER N"me (12) WELL LOG <br /> Tot it dclith, _C)-G4 t Depth of completed w eI! r1�03k <br /> ddreas frnm ft to ft Fran-ttinn (Desenbe b, ctolur charlcter site or matenal) <br /> it, LA}THROP CALIF ,ip - 46 gand <br /> 2i),tL2�fLQN��UI VELL (Stet- inctnict,on` _ rr,, clay <br /> O„iter s M e11 N umber C 4 Y1 <br /> ell iddress if different from Ibrive 4 - 60 clay <br /> ,.reshipI S �Rani.e— 6F. _secnr+n 60 - 70 sand N -1> <br /> i, ince front ities roads riitreiad, fence, etc 70 - QC `� �,1ay <br /> 92 - 9 73d <br /> c ay <br /> 1 -1 sand <br /> (3) TYPE OF VF ORR 1 8 z170 clay <br /> Ness N1 ell M Deepenin& ❑ 17 bb Sand <br /> htc tn,troition ❑ 1 _ 5 clay <br /> Recimelmoninl, ❑ 195 -sand <br /> Horizontal 11 ell ❑ -224 iz-71 ay <br /> Destruction D+ (Descnbe -2 Lj Zj sand <br /> destruction materials aM <br /> prrx-edure, to Item 12)' - --c 'a�T <br /> (4) PROPOSED USE - Sa n <br /> D,,mestic ^ Njai - ay <br /> Irrigation ❑ _ <br /> sa-d (• <br /> Industrial Cl <br /> •` 1 <br /> Test NN,ell ❑ 1 - sand <br /> st(xl. ❑ 369 -372 clay <br /> dh Municipal 0 372 -330 sand <br /> lqw WELL LOCATION SKETCH Other t Es iqrt: t 3bo _ clay <br /> I EQUIPMENT (8) GRAVEL PACK 404 -414 sand <br />-Vtn ❑ Re,erse ❑ Yes ❑ 1\010 size---L, - clay <br /> ihle ❑ Air �3 ^ y <br /> C_t eter of bore � 22 -4.36 sand <br /> her ❑ Bucket <br /> ` {' <br /> ❑ pa ,from to ft `t 6 -478 �' <br /> 8 <br /> CASING INSTALLED ♦ (8)`PERFORATfONS \ ^, lay <br /> 8 n <br /> I, a d <br /> e1 ( Plash, ❑ CCSneYe� � ~ -te Tv pe of perf�r>tkien Ortze of screen, - 2 -5o4 clay <br /> From To Dia G r F �1 To <br /> ft ftp in 4Va11 \\ ft s zA> <br /> X03` 7 g 320` 32,8' <br /> ua er f o - <br /> 35 <br /> a'v - <br /> o , 1 - <br /> I) WELL SEAL2pp,,�� - <br /> r+ surface sanitary sell pmsided- lesm 482❑ if ve492deltth ft - <br /> crr strita seated I&Rinst pollution> ]e, ❑ No ❑ Internal ft - <br /> thod of seatui \I orl, start ly Completed 19 <br /> 3) WATER LEVELS WELL DRILLERS STATEMENT <br /> lith of first water if knro„ ft <br /> This uedrilled undo my tr+rndieAan and this report it true to the hest o/ my <br /> indtng level after well uunplehua ft l.nowfedg and and befr(( <br /> 1) WELL TESTS Sic-,Et) <br /> 1+ well test made' les ❑ NO ❑ If nes b, whum�_ (Vyell Dnller) <br /> 1> of test pump ❑ Bailer ❑ Air lift ❑ EATON DRILLING CO INC <br /> Oh to w NAXiE— <br /> �ler 1t nt�rt of test ft At cnd of test ft (Penur) firm or e,omoration) (Tvped or printed) <br /> ^hrtrge______gallmrii after hours N Iter lemperatiuv Address CC <br /> 'Ll analysis made? lesClio Zip�5l7Qar'L_ <br /> ❑ No ❑ If ,es by Whom' <br /> s tri, loy. madery I es ❑ No ❑ If n e% i"ach copv to this report Liccnse No 11178 i0a Date of this repnrt <br /> 8 fREV 7 78i IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />