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ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In
<br /> File with DWR (Saceioas 7079,7090,7091,you,Wase,Ceae)
<br /> THE RES RCES AGENCY OF CALIFORNIA N° 44909
<br /> DE}�A2ENT OF WATER RESOURCES sitrWell ND?d S�'�
<br /> '�- Other Well No
<br /> (1) OWNER: (11) WELL LOG:
<br /> Name F 'I'I[-�DL-/ Tat.)d.mh •�/� l.. Drv,h.rt.mvleaa.dl.��/O
<br /> Address z / <i? Fnrm+..an: DnmD.by retro,rb.wln,nv o/w+lrrf.l,,el rr,vf.,e
<br /> a.rn re.
<br /> (1) LOCATION OF WELL:
<br /> ro.n,y kx • Dw.<r a number,if any
<br /> r...•hI .a.na...rd S.ernn - •� / '/J
<br /> Di...nt,from tai...rnaar,r.u...d..«t. »c
<br /> - r F G" P Rc6l
<br /> (3) TYPE OF WORK (check):
<br /> Nm Well Deepening ❑ Reconditioning [3 Destroying 1] /930 — .,e)
<br /> It destruction,describe material and procedure in Item 11.
<br /> (a) PROPOSED USE (check): (I) EQUIPMENT: [` AA'ee;-�V C'/n
<br /> Domestic2'Indwtrial ❑ Municipal ❑ Rotary ❑ - t ' "ncF7
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cable _EEr - [ !; a ,l/ ,'/Jf — D
<br /> Other _
<br /> (6) CASING INSTALLED: - (, /, nCre-Vr"1111
<br /> STEEL: OTHER: If gravel packed
<br /> SINGLE DOUBLE [:] .7 - -'.7[•�- /j�C J.f/ �� /r'1C'[C
<br /> Gage Diameter
<br /> From To or
<br /> of To -•7.j< /N7C(
<br /> ft. it. Diann. Wall Bore
<br /> ft. it. ,71' '--.�'(a N 64 V o/_
<br /> .tSiz1 /;I—
<br /> Sar
<br /> e of Ah .r veli eines. /t SL,oI.rand:
<br /> De.cribe ioint �)Czw e. •=4P
<br /> (7) PERFORATIONS OR SCREEN:
<br /> T".of verf.r.unn n......f at—. 010111E
<br /> Pert. Rows
<br /> From To per per Si.
<br /> ft. it. row ft. in.x in.
<br /> (s) CONSTRUCTION:
<br /> W., ., ,.I vrodd,d) Y,. No ❑ To wh.t d. ,h h.
<br /> W.. my. .led aeai ,pollu,on) Yea❑ No❑ If 9•• a d.p,h
<br /> From . f,.
<br /> '7;',3-,— ,Com leted /2.a,—
<br /> Fro. f
<br /> N„hod.f ee.nn, WELL DRILLER'S STATEMENT:
<br /> (9) WATER LEVE 9S4 Tb,, urll us, drilled under my jurisdiction sad ibis report it true to the best
<br /> /. of my kno •l dgr and belie).
<br /> D.D,h at which roue .a fin< found, it Y.o.n ft. )
<br /> Sundi.E level bdortrped.ntine, if known it. NAME ��- cep F�/•-�e�//�/�u. r
<br /> S,..din I...1 at... ,rf—dne .nd dnelo in to (p.nnn,firm,or<.rpmoio.I (ry0rl or Printed)
<br /> (10) WELL TESTS: Adder•.
<br /> W..pump tot made) Yea ❑ No 0 If 9ey by whom)
<br /> Yield: Pal./min,with f,dnvd.n.aft.. hra. s,GNED ..O
<br /> TemDuamre or roarer Wo•eh<mieal anal .i.madd Ye, F] No 0 _ h
<br /> W..electric to m,de of wdD To 0 No ❑ If Yu,.".ch to r 19_
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR 108 (REV. 0.e3) .... e.N yule O. Gov
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