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)RIGINAL STATE OF CA41FORNIA Db not fill in <br /> Pie with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 2 7 0 3 6 <br /> +Ice of Intent Nn WATER WELL DRILLERS REPORT <br /> ,4.'enurt No or Date--_7_7= 08w P- 41 — d p0— State Nell 1 A <br /> —r Other M ell \A <br /> ,NEft �,s,rne Frank I•�endes 12} «SELL LOG <br /> 8 89 So a McKinley Total deplh130_ft Depth of rnmrleted iicI1116 i <br /> Manteca <br /> ft to it Fnntntion (Desenbe b, n+]nr cLara,ter eine or invenal) <br /> Manteca CA. 0-1 Sand <br /> } LOCpATIO�t OF «rE� L f See instructloms) 1 —1 Clay <br /> ' <br /> Occ nets %%ell nirmbcr ' 18-21 Sand <br /> ' .+ddre�c if diflereut rt+n+m ghnc a 21- 33 <br /> 1—i3 Cl <br /> nchrr fl S Iitn�c 6� Jectio — <br /> I,ntefrim ,hiss ro ids rulrr-ids fences etcT, mile $ouch of — O � ;\ C <br /> Hwy. 1ray <br /> 20 on west side of 0-76 N \111 Sand <br /> McKinley, 7 - 0 \\ " Clay <br /> 0-87 Sand <br /> (3) TYPE OF WORK '1 - 10 Cla <br /> \est Well LX De"ning ❑ 11, 1 Sand <br /> Reconstruction E3 — a <br /> Reconditucmnl_ 1 <br /> Horizontal X%ell ❑ <br /> Destruction L7IDescnbe • _ "-�, <br /> destructtnn matenals aid <br /> procedures in Item <br /> (4) PROPOSED `]S* - <br /> Doanestic <br /> Irnti+tion,'" • ❑ _ <br /> Industrial •\ ` ❑ <br /> Test %A ell ❑ ♦ _ e <br /> StoC� <br /> WELL LOCATION SKETCH \`� Other ^\ ❑ _\�`\• <br /> IPME\T (B) GR-%VEL\PACK <br /> in Reserse ❑ �4es� \o`6 Size • '� <br /> W © Air ❑ ` D meter of bore II I \\ — <br /> r ❑ Bucket ❑ 1Zrl..fr0m-7t,Il 116 <br /> CASING INSTALLED'--\ ($�pERFORA S <br /> Cnn et Ts pe of ha !d Lilt < <br /> Q Plastic pe + ono ze n seree5�r �r _ <br /> TOM T Dia r F To � — <br /> ft f in all ft SI v _ <br /> 1 1 0 1 - <br /> � v _ <br /> WELL SEAL <br /> surface slritary seal provrded� ]es ] No ❑ If %es to depth 501 it _ <br /> e strata sealed aeainst pollutron7 Yes M \o ❑ Intcnal _ft — <br /> wd of sealing— Bentoni-re <br /> NN oil. stzrted "'M1 Complete 1 g <br /> WATER LEVELS %%ELL DRILLERS STATEMENT <br />� of first water if know It <br /> This wr!l was drrRed under my prnadrr•h[+n and ihrs report is trot H !lu hcrf of mq <br /> 33ng 1cAcl after wt11 complrhon_ it l.noutrd)ennings <br /> nd helm/ <br /> WELL TESTS SIC\ED <br />,,ell test made' Yes r- No (X If 'es b. shnm' (Well Dnller) <br /> of test Pump ❑ Bider p Air lift ❑ Bro$ Drl gInC��IE__ llln Co, <br /> h to .tester at ,tort nf lest ft kt cod of test ftrpnrat1�nn <br /> 3525`PfManc�a�e live(T,pea or ported) <br /> targe nes!/iron after. t+rnirs V3ater temperature. address , <br /> ICA rrirlysrs made, Yes Cit, Modesto, CA 95350 <br /> Ion � If yes 6� nhurn� Zip <br /> �xtnc Ing mnde� Yes [� ND !f es attach copy to thus rePr+rt 290813 License No <br /> l ate of this report I Q-1 0-7 /�_ <br />+�(nev 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM aaela 950 7 le eoN QUAD(DT ose <br />