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STATE OF CALIFORNIA Do Not Fill In <br /> DUPLICATE THE RESOURCES AGENCY �T <br /> Retain this COPY DEPARTMENT OF WATER RESOURCES 1\?. 111867 <br /> WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No. 75'41q9 U J <br /> (1) OWNER: (11) WELL LOG: <br /> Name Edward Cgreloyxi Toul dtuth 11 n ft. Depth of mmplaed well 110f,. <br /> Address 19055F.,m.0 Dr,r,ib,by colo.,rh...uter,ewe of m...d.f,o.d,...tare <br /> ft. R. <br /> (2) LOCATION OF WELL: <br /> Came, C;.qn janallin Ow miter,;f any 6—:)6 Clay & shale sand, <br /> ga <br /> Tow—hip,Range,and s-6,n <br /> Dm..ev from 6n..,mad,,m;lroads.ea. <br /> (3) TYPE OF WORK (check): <br /> New Well Z Deepening ❑ Reconditioning ❑ Destroying ❑ e <br /> anH <br /> Il destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check)- (f) EQUIPMENT: _ <br /> Domestic jo Industrial E] Municipal E] Rotary f] <br /> Irrigation ❑ Test Well E] Other E] Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEELX OTHER: If gravel packed <br /> SINGLE DOUBLE <br /> Gage Diameter -� <br /> From To or of From To <br /> fr. ft. Diam. Wall Bore ft. ft. <br /> 11n 6-5/ 12 11 85 110 <br /> Sue of shot,.,w11 r;vx: Sat of gravel: pea <br /> Ue.nibr iuim <br /> (7) PERFORATIONS OR SCREEN: <br /> T pt of ceriorad,.n ar name of acr«n <br /> Feel. Rows <br /> Front To per per Size <br /> ft. fr. row ft. in.z in. <br /> (s) CONSTRUCTION: <br /> Wa.a,uriac<vv;n,y a•I provided? <br /> YoW No ❑ To who,d.p,h 50 <br /> ft. <br /> Wer<.ny,v.0,toted axalmt pollution? Yes❑ No❑ If yea, ote depth of strata <br /> From ft. f,. <br /> From B.to L. Wort vaned 1 ,Completed 19 <br /> Method of«.lin WELL DRILLER', STATEMENT: <br /> 9 WATER LEVELS: This well mos drilled under my jurisdiction and this report is true to the best <br /> ( ) of my knowledge and belief. <br /> 0,,h ac which wfi , found,if known ft. <br /> Standing level b<foran n <br /> o,rforatinx, ;f kaon f,. NAME <br /> Sundin Iwd after cerfonrin and devdopin f,. er m,or eorPoranon) y e <br /> (10) WELL TESTS: Address <br /> Was pump wst made? Yet ❑ No If ym,by whom? <br /> Yield: sal./min.rich ft.drawdown after hr, [SIGNeo] <br /> Temperature of waror Vn a chemic l analpi,made? Yes O No JEI a <br /> W..elec <log madeofwell? Yes ❑ NaIED If yeaattach copy License No. Enn—? Dated��n--� 19�i <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 IREV.9.881 67t39-7W8-72wow TRrPOT OSP <br />