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ORIGINAL STATE OF CALIFORNIA Do flof ffa in <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 34 486 <br /> Nutice of bent No. 1 4620 NATER WELL DRILLERS REPORT State %%,ell No. <br /> L<a:hermit No.or Date Other Well No./ <br /> Name JO II I1 Aro r r i s o n (12) NNTLL LOG: Total depth?7 rvi 5yt Depth of completed well 2 <br /> Address 24701 C arti Irv form ft to k mesc <br /> Formation IDnbe by rnlur, character, sue or ms:en.:lr <br /> Cib' LSCn ICy it lip Si0 - J ton <br /> (2) LOCr_1TI0\ OF }FELL (Sre instructions): <br /> - 5 riarc. 2n <br /> Cmmn-� aan -joaruill Owner's Well Number 5 - )2 C12A <br /> Well address if differeot from abov-e 12 - 2 <br /> U <br /> 7oxashiP 1 S nan¢e E SxNo. 2 2Z - bro Y-T; C 1 <br /> Distance from cities, roads, milrnads, fences,etc 9U0 t 1% - 4t- $ <br /> iaKT-FLK Aoau 6001 . ,. st f 48 - 56 b <br /> 24701 .n_:Trp"1.< oac.. 56 - q4 s-,nO <br /> o4 - 76 v <br /> (3) TYPE OF WORK: 76 i)4 -O - <br /> NEI- Vew Well j] Deepening ❑ Yi 00 S. liG .1'ii <br /> ,y'('I' enrnstnrctno _' <br /> ❑ 100 -. `< o r o,, . 1 '1 ' <br /> Re inditioninF ❑ l-8 -121. <br /> horizontal Well ❑ C :� s . <br /> /,,j Detraction C (Describe = <br /> P destmctmn materials v — <br /> prored. in Item " <br /> 1 y <br /> ry I, (4) PROPOSED 2� ,,, � •• <br /> A ` Dmnestfcty <br /> 7 <br /> '� Industrial 113, <br /> 3 S {� _ 1�r ell c <br /> Niun"c' S - lfl <br /> WELL LOCATION SKETCH Other ❑ 'o f,5:1.Ci1C [ nr s j i v a1 +er- - <br /> (5) EQCIPNfENT: (6) CRAPACK: - IC _^.Vltr L: of t-'e ' ac,al Dr <br /> Ratan ❑ Reverse ❑ ❑ No Sire C a^.Slit <br /> Cable E Air ❑ ter of bore - <br /> Other ❑ Bucket -2 ro - <br /> (7) CASING INSTALLED I& ERFO NS: - <br /> 5[eet ❑ `Plastic ❑ Type of pe 'm u e of x - <br /> From T Dia. r F To - <br /> ft. f . in. \Nall ft. Si a - <br /> 0 12N <br /> (9) WELL SEAL: <br /> Was surface sanitar� seal Provided? Yes ❑ No G If yes, to dep h ft, - <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft - <br /> Nethnd of sealiv tt'nrk s-arte `* 19�L. Complet 19 " <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth of first water, if know ft. Thi, .,If nom dr:Tled .ad, my iu ' lklion and If m"n a true to the bat n1 my <br /> Standine level after w"e11 eomplitios 52 ft" <br /> (11) WELL TESTS: S., <br /> W., well test made? Yes t_ No C If res. by whom? (%%-elf Drill.{r) <br /> T ,c of test Pump Bailer ❑ Air lift ❑ NAMF 1 :vile IO :'-ell liIll t',L.. s l IlC <br /> Depth to water at start of test ft At end of test k (Person, firm, or corporation) tT.yd or printed <br /> Disrhame eal'min atter hooses Water temperatureAddress JI::St.' :' 1.9ne SFE-@ �iE C, <br /> cher,ical analysis made? Yes ❑ No ❑ If res. by wb.? p+, CiN. ULkuale 7ip_��- _- <br /> \`'( atric I-C madr? Yes ❑ No C rtes if Yes. anacb copy t� reLicense No. <br /> Dwri iee tReV.7.76s IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM .sa:sosa,-,a xw can fry`s os. <br /> or <br />