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' STATE OF CALIFORNIA Do Not Fill In <br /> ORIGINAL THE RESOURCES AGENCY <br /> File with owe DEPARTMENT OF WATER RESOURCES N? 116576 <br /> WATER WELL DRILLERS REPORT State Well No. y <br /> 9a1.6e Well No. / I <br /> (1) OWNER: (11) WELL LOG: <br /> Name Tosal depth _2,3J I, Depth of completed well :2 35 f[. <br /> Address F., Dearribr by enlar,rn.r.rnr, _ at an.rniul,a rn.,I... <br /> Qsr ern rt. <br /> (z) LO ATIO OF WELL: 3 <br /> e000ty Ow tuber.if any <br /> Townahip,Range,an <br /> Distance Irma—is,, on <br /> nadsrroads,ea. at <br /> 2 170 // if <br /> 0 <br /> (3) TYPE OF WOR (cbec <br /> New Well Deepening ❑ Reconditioning ❑ Destroying ❑ 0 // If <br /> If destructima,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (f) EQUIPMENT: %0 k d/ <br /> Domestic industrial ❑ Municipal ❑ Rotary ❑ 1Z .� 1 <br /> Irrigation [j-Test Well ❑ Other ❑ Cable <br /> Other ❑ SD <br /> (6) CASING INSTALLED: G <br /> STEEL: OTHER: If gravel packed jJ <br /> SINGLE <br /> Gage Diameter <br /> From I. or of From To O e <br /> ft. t[. Diane. Wall Bore ft. ft. <br /> Z Q <br /> n <br /> Size of Aar yr well rind: Q S <br /> (7)ribe �/ <br /> Iu,RFORATIONS OR SCREEN: 3.2 — t/ <br /> stye ter perroranIrinne.fs—e. <br /> Perf. Rows <br /> From To per Size <br /> f[. ft. ro fr. in.x in. <br /> _ I <br /> (a) CONSTRUCTION: l <br /> Wa a amlace saoi—,,seal prodded? Yes yd''No Ely To what depth —3 7 fs. <br /> Were any uou.aled against m1Jmlon? Yn ❑ No ❑ if yes,note depth of strata <br /> tram It. ft. <br /> kr m &.m h. Work asa .ed 19 <br /> Completed 19 7-3 <br /> Nahnd of.eaunp WELLDRILLER' STATEMENT: <br /> (9) WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> of my krmeuledge,and belief. <br /> Depth a which w as first found, if known ft. ) / sI ,/� <br /> iundins leval bef.re perfnraune, if known ft. NAME 0 / /X1.1 /V C- <br /> Standing level after perfor ing and developin¢ ft. ( erso ,hone ure�rpo 4) RRted) <br /> Ori.ted) <br /> (10) WELL TESTS: Address $g 0 4 n VES T RD. <br /> Was pomp tae made? Yes ❑ No ❑ If yes,by whom? <br /> Yield: ¢il./mita.wish I,drawdown af... In, [SIGNED] <br /> Temperume of water Was a chemical analpis made? Yes ❑ Na ❑ (Well Drily,) ssa��waa <br /> Wmelec cl mad<of well? Ye N yes copy 27 <br /> f /3 <br /> I., s ❑ o ❑ 1( tech License No. Date ^ 19-a <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> a <br /> D W R 186 I RE V, 9.681 ......)p0 6.>a]OM 1pip <br />