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(43 7 <br /> 'ORIGINAL STATE OF CALIFORNIA DO not fill m <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 3617 2 <br /> 611 <br /> of Intent No WATER WELL DRILLERS REPORT stite Abell <br /> 'rmut No or D tt� ..Oa�he[ Lt ell \u s <br /> 11,ldrLs, <br /> OWNER \,,, J (12) WELL LOG Totil,hptt-12,Elt Depth of completed weft ft <br /> 1�- my-, (ver A-ye tram ft to ft D)nnrhun iDescnhc h� asl,ir chtuxter size or matennl) <br /> l i, QMl t �`�.y L1 Q 1 -1 fia;-a:I a r'tp <br /> 21 LAC XTION OF'WELL r See -nstIULUun, d brown <br /> rivet, 0%tier s %t ell \mnhrrbrown <br /> II ,ddr�- il ditftrent tion ibosL 1 62 sand fame to course <br /> 62 - 68 cls brown <br /> 1 —10"p— R inti 5e h,n b <br /> D,t tru c it 511l uties ro ids r utr4,ids tenses etc - 72 sand <br /> 72 - 81 claz brown <br /> 81 88 sand <br /> 8 110 clay & sand layers <br /> (3) TYPE OF WORK 10 126 sand & small layers of c <br /> New %I ell YE Deepnnmp, t_j - <br /> Reconstruction ❑ - <br /> Retiindttiomni, ❑ <br /> 1[onzuntal %%,ell © - <br /> Destruction E, tDescnbe <br /> destruction m ttenils Ind <br /> procedures in Item 12) - <br /> (4) PROPOSED USE - <br /> Domestic 2 - <br /> Irrigiteon ❑ - <br /> Industrial ❑ - <br /> Test tb ell ❑ <br /> Stock ❑ Y <br /> Municipal ❑ <br /> 1 <br /> WELL LOCATION SKETCH Other ❑ - <br /> 1r;) EQUIPMENT (6) GRAVEL PACK = <br /> Ratan Reverse ❑ Yes x No ❑ Sur <br /> C t'L kir ❑ Diameter of bore 11L - <br /> �1t'tr ❑ Butket Parked front 9-1'i L+�_ft <br /> T) CASING INSTALLED V (8) PERFOR;TIONS 811 - <br /> Steel X1 Plastic E] Concrete L] Type of perforahun 5r sire nF screen <br /> F rout Tu Dia G-kge or Froin To Slot - <br /> ft ft in Wall fL ft size - <br /> - <br /> 12 S6 <br /> (S) WELL SEAL - <br /> %%as Hurt ILL eanttary seil prut ided ]es:c \o a If ,es to depth ft - <br /> tt tri strat t sealed i-iinst pollution' S es 0 \, InteTvil ft - <br /> Sfethod if setlinr1�etonl to 1 ttork started_ I9 <br /> Completed- <br /> 1 10) W kTER LEVELS WELL DRILLERS STALTEMENT <br /> DLpth 4 first titer 5f knon ft Trtu cell uus drilled u+oder mu iartrduta++t and lhi, r4t+ort +S ime to the hest of m, <br /> S tandtn� leti cl alter w etl cornpletto <br /> knowledge and belief <br /> W ELL <br /> t4 w will test uude' kis \o [j [f sex hs „hours It (Well Driller) <br /> T,,pe of test Pump 1 Bailer L, Air lift E] NAME Walter rr. Noack & Son Tne- <br /> Depth to w itL r it start of test _ tt tt end at test ft� l Pers,?b firm orcorporation t Typed or pooled)Dtachame gil min ifter hours tt iter temperature Address P-n_ r^rix 1 1 )✓ <br /> Cts Stockton L3��CLrt11a z 201 <br /> ip_ 95 <br /> rc it to ilss5s midi.' YLY ,_, \u ❑ ! �"-7�7m--'-"-" <br /> rlettnr_ log, nt«1r' Srs ❑ \u ❑ If ses ittt�li Lops to this report License \n„(,�\L =# Date of this repn2 <br /> �t 3 ,REv 7765 IF ADDITit7NAL SPACE 1S NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM .a{i{ass 7_r{sew oi:wa +�ir CS <br />