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STATE OF CALIFORNIA Do Not Fill In
<br /> THE RESOURCES AGENCY
<br /> TRIPLICATI DEPARTMENT OF WATER RESOURCES N2 97716
<br /> Rattail, this copy
<br /> WATER WELL DRILLERS REPORT state Well No
<br /> Other Wall No.—
<br /> (I) OWNER: (I(�.WM I) WELL /LOG:
<br /> Jf /9
<br /> Name ohG
<br /> n fl�, T—I d,h
<br /> Address- -- 15221 !.o RL:PO Oedf
<br /> Vrcam Bet OOIIdacta 'r,. 50
<br /> (2) LOCATION OF WELL: 3rittle brarm Cl 50rt 68
<br /> Sea Joaquin Bra= send and P travyi
<br /> T.,nmb,p,Nan ..d s<. R-7—AleTecta 9 Hard chtin" a clr.• 6Z 6S
<br /> G<, 7
<br /> r,,,da�,.,l,,,adr..n..t 0 sest of HI 99 Crevol t0 iff 74 86
<br /> mDrcn of Lempo Rda abom address 5 braTa of 65 80
<br /> (3) TYPE OF WORK (check): :oft braa cl - 112
<br /> New Well Deepening ❑ Reconditioning 0 Dearoying Brown Cl 112
<br /> //Jr+lrnrhon,Jmnibr maferi.r and prorrJFre in Item l 1. fir_ Band tmd 1;T'epel ~ 122 126
<br /> (4) PROPOSED USE (check): (T) EQUIPMENT: flard ey claw 111ty
<br /> Domestic;1] Industrial ❑ Municipal ❑ Rotary ❑ Brmm Ol
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cable Clfw rad card lE6 171
<br /> Other ❑ Gmr rvmd rnd0!"91 in 171
<br /> (6) CASING INSTALLED: !k ct.1 at taa al On
<br /> STEEL. OTHER: If gravel packed Sanctr Sanbrorm O_l_rJ
<br /> SINGLE DOUBLE -'!ity
<br /> ft77 .r{cmn srzd 194 toy
<br /> Gage Diameter Ilatd and wdicmt t4m vj@y 197 218
<br /> hrnn b or ofErom Tn CI =d all
<br /> Di.m. Wall Bore fr. fv. rmngl;W .l
<br /> C
<br /> 12W 17 Brown sand.lotc cf zaaa 233 �
<br /> 0 4 10 bSediaR braTa CIV 235240
<br /> 240Chun, bra.-ti
<br /> .-ti and brom-2 MRnA 24a WA
<br /> u<,Lne<e.,,, Baht 916 (R
<br /> (7) PERFORATIONS OR SCREEN: —'
<br /> Pelf. Rows �
<br /> From tper per Svc
<br /> f
<br /> P
<br /> f[. f[.. row f[. in.x in.
<br /> a
<br /> (I) CONSTRUCTION:
<br /> W,.amr(.ce,coir.,v+eal Dro.ided= YXZ N. EI T..6,d,,,h 40 L.
<br /> Wer u�Y• ,nl<d,.um,polm ont Yes❑ No Q If Ye. .depth of a,
<br /> o L. f,.
<br /> fr. Work mnrd Compl<,N 19
<br /> aaab<d.1 walm WELL DRILLER'S STATEMENT:
<br /> (9) WATER LEVELS: rb„ well us, drilled Ynder my jaruJ,rtion urrd this report i, frar to for bele
<br /> of my knmrl+dgr and belief.
<br /> Urorh , .hic6 r as tiny food, if k— ,,. ;
<br /> Am&ata bwl Is.fure perfnn Jox, if It.... f,. NAMESrn
<br /> lrandin I...I alsrr ler f.. ,re .nd dvdo in, 1,, i.P<rwv,brm,or eorD<nnonl fTv .pintr
<br /> (I o) WELL TESTS: Address
<br /> SW TV Kett2jmman Latin-
<br /> lf.so N„ ❑ If rr,,by.bom>
<br /> YWd: ,d./ai .uh /s.4,udu.n<fu, hr.. SIGNED
<br /> T.69.1.1n uf. W., i ica1,nJ9a.m,dd Ye ❑ N. 0 J lidl O.iueq --
<br /> �r Li.... No, 1721"11 rand .T1Surry _u—_. Ia
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR 168 inr.. s..yn. ,a.. .a.... .... ....
<br />
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