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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY ni <br /> File with DWR DEPARTMENT OF WATER' RESOURCES No. 22652 <br /> Notice of intent No.- WATER WELL DRILLERS REPORT State Well No. <br /> Local Permit No_ or Date Y � ., <br /> +! 7 9j� Other Well.No <br /> (, (12) WELL LOG: Total depth__5_15_ft. Depth of completed well__A�'f(! <br /> A( from ft. to ft. Formation (Describe by color, character, size or inaterial) <br /> Cl 0­3 Top soil <br /> (2) LOCATION OF WELL (See instructions); - Clef <br /> County__ 3an__,T_Qaquin __Owner's Well Number 5-9 Sand <br /> `�'� <br /> Well address if d <br /> tif�ferent from above <br /> 9-x34 cla <br /> Township �t1�--Ranke R6E Sectio 34-37 No( Sajid. .! <br /> Distance from cities, roads, railroads,fences,etc, Thornton Rd. ;c a y <br /> wmi. North of Eight Mile Rd. , West side d)i�- <br /> =6 clb' y <br /> 64-69 '� Sana <br /> (3) TYPE OF WORK: ;rk63 'May & shale <br /> New Well X Deepening ❑ 1 5Z200 Good sand <br /> Reconstruction ❑ 200-2Q . Blv�,cday & shale <br /> Reconditioning ❑ �' �212/ = 1e�blue sand <br /> Horizontal Well o � , 2-223 e' c la y <br /> Destruction C1 (Describe ! ' \ I'Iu an <br /> destruction materials d <br /> procedures in Item 2 =2 'glue C 1 `/> <br /> (4) PROPOSED US 2 3 0=2 Fair ,-U'67e�)s'and <br /> Domestic \41 2 1 438,�: Bl as <br /> Irrigatio `� WB�u,L3 .�h\ le <br /> Industrial \ ❑ <3, 9Z-1-3, 60 Frdelblue s and <br /> T�1. <br /> est well o ;;\3 Q1' -3 5 Blue„ clay <br /> \\ ) 3 " the blue sand <br /> i pa '-390- .,1 '� _LU <br /> e c ay <br /> WrLL LOCATION SKETCH other ❑ 3 0 "Q� Blue sand <br /> (5) EQUIPMENT: (6) GRAVI!,Yi,PACK: �. <br /> N bid e 440-49W Blue clay <br /> Rotary ❑ )reverse � �ks�I No Q Size 5 Fine Blue sand <br /> Cable ❑ Air ❑� rtaitlFter of bore 1 Blue Qua <br /> Other Cl Bucket 1:3RFk�rl\from 0 \t �J1�-M50 t� \� — <br /> (7) CASING INSTALLED(( ,' (811PERFORAh slouvered — <br /> Steel]] Plastic C1Cd�iO{et q Type of pe P6,n of size of scree + — <br /> Froin T4—, Dia. r From`\ To ; - <br /> ft. f(.(\\ in. Wall '\� ft. , size - <br /> at' �l 4 15 \:> 459 N"51 2- <br /> (9) WELI. SEAL: <br /> Was surface sanitary seal provided? Yes Q No 1$; If yes, to depth, ft. <br /> Were scrota sealed againstpollution? Yes [� No [l Interva)*--_fit. — <br /> Nfethod of sealing Work started_ — -ig= completed-__ ___19___ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known r7 ft. This well was drilled under myjurisdiction and this report is true to the best of my <br /> __ <br /> Standing level after well completion3 / e� knowledge and belief. <br /> (11) WELL TESTS: n SIG\ED L2'L� Z✓L <br /> Was well test made? Yes.M No [7) If yes, by whom? P•G•&Er (Wulf Driller) L <br /> Type of test Pump Bailer❑ Air lift ❑ Hennings Bros Drilling <br /> NAME—_-.-- �.� In.e.— <br /> Depth to water at start of test I. At end of test___ft a ,fi4•Cr Drab pri (1) <br /> Address 250 i�1n. t;F�ifo`�e �$. <br /> (Typed or nte <br /> Disc ,Typed <br /> &al/min after 11 hours Water temperature -- <br /> Chemical analysis made? Yes U No M If yes, by whom? City Modesto , Cam Zip 95350 <br /> �" lctric !off made? Yes ❑ No If yes,attach copy to this report License No. 290$1(�13 Date of this report- <br /> 188 <br /> eport2-2i_-77 <br /> 188 (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 436)6-9507-7650'4 ooADCOros. <br />