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STATE OF CALIFORNIAORIGINAL <br />File with DWR <br />Notice of Intent No.. <br />83-566Local Permit No. or Date. <br />(1) OWNER:A. <br />toAddress. <br />City- <br />Welt address if different from above. <br />Township..Range. <br /><\ <br />Reconstruction <br />Irrigation <br />Industrial <br />T| <br />Stod <br />WELL LOCATION SKETCH <br />Cable <br />Other Bucket <br />Plastic-^)Steel <br />72 \ <br />2a a. <br />Interval Jt.No <br />Completed.19. <br />ie to the best of myT2 <br />Signed.N <br />N° g 7.C., INC,NAME. <br />A <br />Address.Water temperature. <br />City. <br />1 9q3.Date of *his report.License No. <br />IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORMDWR 180 (REV. 7-76) <br />Zin 95356 <br />lev, <br />1 <br />r7 <br />Discharge gal/min after. <br />Chemical analysis made? <br />Was electric log made? <br />Yes <br />Yes Q <br />If yes, by whom?„__________ <br />If yes, attach copy to this report <br />Reconditioning <br />Horizontal Well <br />Air lift O <br />At end of test <br />THE RESOURCES AGENCY <br />DEPARTMENT OF WATER RESOURCES <br />WATER WELL DRILLERS REPORT <br />________S e c tio 1 j____________ <br />South Side of <br />.ft. <br />A. <br />O 1 <br />Distance from cities, roads, railroads, fences, etc.. <br />Freeway at Eossdale <br />Do not fill in <br />No. 247092 <br />szz: <br />From <br />ft <br />0 ~52^. <br />(2) LOCATION OF WELL (See instructions): <br />cm.ntA- dan Joaquin Owner’s Well Number. <br />NamP STARKEY »S MCBILEHOME PARK <br />36 W. MOSSDALE RD. <br />LATHROP , CA <br />Reverse Q <br />Air <br />State Well No <br />Other Well Xo.^^-S S 2 '! <br />Destruction (Describe <br />destruction materials ainj <br />procedures in Item <br />(4) PROPOSED <br />Domestic <br />(3) TYPE OF WORK: <br />New W’ell^fj Deepening Q <br />ML <br />^Screen <br />< - <br />______hours <br />No K <br />No ffj <br />(5) EQUIPMENT: <br />Rotary <br />If yes, by whom?. <br />Bailer O <br />.ft. <br />Work started - « 4 19 ^3 <br />WELL DRILLER’S STATEMENT: <br />This well <br />knowledge <br />was drilled under my jurisdiction and this report is <br />(Well Driller) <br />EEKLTNGS BROS. DRILLI?. <br />' Person, firm, or corporation) (Typed or printedi <br />"525 PELANDAlE AVE. <br />MODESTO, CA <br />70813 <br />Pia- <br />If yes, to depth. <br />- -9% <br />Mm-' <br />- <br />Xx , <br />?x9 ~ <br />Zin 95330 <br />(9) WELL SEAL: <br />Was surface sanitary seal provided? Yes Xl No <br />Were strata sealed against pollution? Yes Q <br />Method of sealing____________U0 il.it;n*t <br />(10) WATER LEVELS: <br />Deptii of first water, if known <br />Standing level after well completion. <br />(11) WELL TESTS: <br />Was well test made? Yes <br />Type of test Pump <br />Depth to water at start of test <br />□_________ <br />(7) CASING INSTALLED: <br />C<^r»te <\ <br />Calie^or <br />Wall <br />160 <br />Municip; <br />> Other <br />(6) GRAVEiXPACK: <br />- n°X <br />\ ■QtahjXer of bore____ <br />XiLasfrom_ 20 tXN _ftd <br />( 8)'PERFORATIONS: 'X <br />Type of perforation or'srke of screen/ <br />To <br />ft <br />?2X <br />size, -G-bd'V.eL <br />X 72 <br />9“) WELL LOG: Total depth 72 ft Depth of completed well ( <br />from ft. to ft. Formation (Describe bv color, character, size f>r material) <br />0 - 3 Top Soil__________________ <br />3 - 7 Sand <br />7 ~ 15 Clay <br />15 ~ cP Sand <br />60 - 65 Clay <br />65 - 72 Sa^cXw