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QUAMUPU� STATE OF CALIFORNIA DD not fill SH <br /> Uft of complyTHE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 156304 <br /> Somice of Intent No. <br /> WATER WELL DRILLERS REPORT state wen No. <br /> Lend Permit No. or Date Other Well No. <br /> (1) OWNER: Name (12) WELL LOG: Tota)de tt <br /> p (t. Depth of completed welL_fr. <br /> Ad.ares front ft. to ft. Formation (Describe by color, chamcter, size nr material) <br /> Cio Aesepo Vip 0 - 3 ton soil <br /> (2) LOCATION OF WELL (SeeinstrWels): brn sol.bra sand loan <br /> Ola <br /> County gss) JOaQU1>• Owners.well Number - <br /> dy <br /> Wall address if different from shareT 8!I qg wand <br /> Towarbip Range Lectin rn clay <br /> Distance inrm cities, roads,railroads, fences,etc 92 - sand snd Q e a rs a sandy clay <br /> 103- 113 m6nd -4111 P60 grOV-01 Und UP-ad <br /> (3) TYPE OF WORK: s g, c1a� <br /> l�f� <br /> —TA <br /> >xlc� cid mea -ravel <br /> New We1Liiil Deepening ❑ <br /> Reconstruction ❑ 114q-1,43 noir z,2d P®jL_ya"41 ninnIn(t• <br /> -CRVemoditioning Cl - <br /> R, IJA <br /> j = Horizontal Well C31'1 <br /> 1(0 17R rn nI fly <br /> / Destruction ❑ (Describe - <br /> 17 <br /> destruction material, ad <br /> Procedures in It. 12) 179 - tonsd r» <br /> vel <br /> (4) PROPOSED USE: - 196 brn brittlal r.1py. <br /> fl Domestic .Ll - <br /> 3 i w »OVAI <br /> Irrigation ❑ 19r - <br /> V Industrial El - hrn _ , <br /> Test Well ❑ - b ctandsrf, <br /> ana (miss) <br /> Stuck ❑ - 24 5 l <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (6) GRAVA�,PACK: - .t S t , <br /> TV— <br /> Jimmy ❑ Reverse ❑ Seo ❑ Nog Stze - (� <br /> Cable It Air ❑ Diameter of be - <br /> Other ❑ Bucket ❑ Packed from to_._—_tt. - <br /> (7) CASING INSTALLED: (B) PERFORATIONS: - O <br /> Steel Photic ❑ Concrete C'' Type of perforation or size of screen - <br /> From To Dia. Gage or From To Slot <br /> ft. ft. in. Wall ft. ft. size - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yeslp No ❑ If yes, to depth_50—fL - <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval 7V k. - <br /> Method of se Work st 9 Complet 1 <br /> (10) WATER LEVELS: WELL DRILLERS STATEM T: <br /> Depth of first water, if knowe R This well tons drilled under my ferisdictom end this report is true to the best of my <br /> Standing level after well comPled kmwledge.and.-Lylief__---_ <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No� If yes, by whom? (WenD er) <br /> 'type of test Pump E] Bader ❑ Air bit ❑ NAME THAW <br /> Depth to water at start of teat k. At end of test—ft ur, an,or torpors m Ty or prirrted) <br /> Diselarge gal/min after tours Water temperature Address <br /> F0 Box 361; <br /> Chemical analysis made? Yes IDNo ❑ If yes, by whom? City w - Zip -- <br /> Was electric log made? Yes ❑ No ❑ If yes, artach copy to this report License No. ate of this repo <br /> DWR 188 (REV.7-761 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />