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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY NO 94604 <br /> TRIPLICATE DEPARTMENT OF WATER RESOURCES <br /> Retain this saPr WATER WELL DRILLERS REPORT7L—636 <br /> State Well No. <br /> Other Well No.-671-2,717 2-- <br /> (1) <br /> (1) OWNER: t (11) WELL LOG: <br /> Name - 1 T.,al depth f,. Depth of compler<d well fr. <br /> Address ' /- Fom,atlon: Dnr.iGr by rola.,rba..rbr,aiu o)w.mriet,and mart... <br /> j,�p� 1,�IO W7 / @. <br /> (Z) y Il%<�✓ ?.1F 'OL'1 ' <br /> TownAip.Range.and Srction / , I r f�� �• / <br /> Disnnce from cilia,road.,railrmde,etc. � <br /> (3) TYPE OF WORK (check): r- <br /> New Well'❑ Deepening ❑ Reconditioning E] _.Destroying ❑ tirt <br /> 1/destruction,describe material and procedure in Item 11. <br /> (4) PROP SED USE (check): (5) EQUIPMEN n <br /> Domestic D Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> S7 EL: OTHER: If gravel packed <br /> SINGLE EJ DOUBLE ❑ <br /> Gage Diameter <br /> From To or of From To <br /> —1t 11 Wall a ft. <br /> r Y T <br /> Slat.f shoe ur well Tin sire of aravel: <br /> Ue.nbe?elm <br /> (7) PERFORATIONS OR SCREEN: <br /> Trve of perfua,i.n or tete.of screen <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Was. refeer..eerery aeal v,.vid,d? Ya ❑ Na ❑ To what depth !e. <br /> Wer any. Baled aavinu v.11uri.n? Yes❑ No❑ If yes m devrh of s <br /> From ft.r. fe. <br /> Ennn %So fe / h Workb, reed 11 .Completed 19 <br /> me,hod.I ea,. WELL DRILLER'S STATEMENT: <br /> 9 WATER LEVELS: This weft w'as drilled under my jurisdiction and this report is true to the best <br /> ( ) o/my knowledge and belief <br /> r . 4;:—) _ <br /> D<p,h ar which Ovate waa fiar found, if lo.... 1�, f+—' <br /> i �, d. <br /> n � �..i �._. <br /> Snding level bef.reperfoneina, if knowlo....n NAME - ' <br /> )...ding level a(nr <br /> perforating and developing E;. <br /> (P,,—,firm,or carpara[ion) pay ii.frd) 1' <br /> (10) WELL TESTS: Address " a" e-•� <br /> Waa pump veer made? Ye, ❑ No ❑ If yea,by whom? <br /> Yield: aal.lmin.vieh I,drawdown after here. [SIGNED] ' <br /> Tem [wurer W.r a chemical aval <br /> (Well f}aalrr)r <br /> peumreo yds made? Yea ❑ No ❑ <br /> Waselendt Iva m.deof well? Ya ❑ No If ye.,aaaeh eupy Licenze Nn.. Dated 1� <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 tFE, 9.68, zsv._ssp n_se a..ram L.plea <br />