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ObADRUPUCATE �AATE OF CALIFORNIA DD not rill in <br /> Use tocomply with Y�rERESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 118385 <br /> wine of relent N... / NVATER WELL DRILLERS REPORT State WeB Ne. <br /> L:acal Permit No. or Dau- ? Other Well No. <br /> (1) OWNER: Name ✓� : K< > (12) WELL LOG: Tonal depth 590. Depth of¢ompl=tea weu f <br /> from R to ft. Fonnadon (Descrihe by mlor, character, size or material) <br /> Address 9)r <br /> City— <br /> Zip _ It-7 <br /> (2) LOC T N O W LL See instructions): = i/.ve .E <br />` Cmmty � � �,6h V//L� Owners Well Number <br /> Well address if diffe a t�f(r/om above - 'Z <br /> Z_ <br /> ki3CC- C'yt.d✓�I <br /> Township Range .sectio <br /> r/y M/Lt= lA/E"S <br /> taft.. <br /> Disnce Imre cities, mads, milnmds, ,etc _ y <br /> cr 111W1y y �/e �c:LTs/ aF - NG B CL.j <br /> li E <br /> 1,31E <br /> yyOF WORK: y 7/�-"P/ <br /> New WeB r� Deepening ❑ <br /> Recoretmct(on ❑ <br /> Reconditioning ❑ <br /> a Horizontal Well ❑ — 9N <br /> Destra tion ❑ (De <br /> scv e <br /> destmm <br /> ction aterials LT , <br /> pm.dures in Item - <br /> ACAMO �D (4) PROPOSEDik L �xi ve <br /> Domestic .lH NU 71>'vE (/1KT) >NI,10 <br /> Irrigation /tt7t 7 N L y <br /> Industrial ❑ - �� /'r IJ .j k'1r`CE I JC lr <br /> T WeB ❑ <br /> Stc -7,9H.L '. <br /> Mnnicip 7/7/11V CL✓ Y <br /> WELL LOCATION SKETCH other ❑ LI/7EiV N <br /> (5) EQUIPMENT: (6) CRAV ACK: - COr%�SC-- /4HT AN(J <br /> Rotary ❑ Neverse• ❑ ❑ No Sia HIP ^OEP 7 <br /> Cable Air ❑ r. bore - - r// _I <br /> Other ❑ Bucket ❑ m h L l <br /> (7) CASING INSTALLED: (8) PEItFOAA Y r//✓.C/ ff' y <br /> Steel Y]. Plastic ❑ C' � e Type of pe r>ze of scree U NN / <br /> Fmin To Dia. Ga r F To <br /> - C Y L// <br /> k. ft i Wall ft. ft. i — �v� V 5✓vL.�Nij' iHn' f II <br /> 577 _477 Arl i <br /> (9) WELL SEAL: ' <br /> - C _,' <br /> Y. 0 <br /> Was surface senitnry seal provided? Y ❑ No LT If <br /> to yes, depth fr, /v/EJB T/)tLt✓ c1/91K <br /> Were strata sealed against pollution? Yes ❑ No,rT Ivterval ft. / & <br /> Method of Beano Work started Ui Complet^f 19 <br /> (10) WATER LEVELS: �G=7 WELL DRILLER'S STATEMENT: <br /> Depth of first water, ll know ft. This ledallg tuna dr llsd17.f Ire ju tion apd t,i.v ep` ort is tree to the best of rep <br /> Stnndivg level after well rnmpletiooPiv ft. Anotuledge and G¢. <br /> (11) WELL TESTS: 'Sa^'-✓c^'fit•'" SIGNED— <br /> Was <br /> IGNED Was well test made? Yes a No ❑ If yes, by wham? ro ( L rJ) <br /> Ty of test Pump (P Bailer Air lift ❑ NAME G/�''5e� <br /> Depth to water at start of test � ft. �7/ At end of les h (P op, gyp us�ortmration) (TYPed or Printed) <br /> ft Cafter--AL—hours Address �`� <br /> Discharg al/ruin ,,yyWater temperature [n`l`./t•�E/I/ t <br /> Chemical analysis made? Yes ❑ No l'T If yes, by wbom? City /---�-9— <br /> Was electric log made? ' Yes ❑ No If yes, attacb copy m this report License No. '� nate of this repot /7— <br /> / / <br /> DWR 188 (REV.7.76 IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />