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STATE OF CALIFORNIA Do Not Fill In <br /> DUPLICATE THE RESOURCES AGENCY NO 111858 <br /> Retain This topY DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT State Well No. C <br /> Other Well No. 7J-422 W <br /> (I) OWNER: (11) WELL LOG: <br /> Name Muret Clausi Toul depth 0 q e. Depth of<nmvleaa wdl ft. <br /> Address 20 it Forma»on: Desnib,by.nen.,rlur.en.,» o1 en.rerl.f,.RdMantpr-as Calif. Q-1 5 rn.rn.e <br /> t.to Snnd ft. <br /> (2) LOCATION OF WELL: 15-2f) Clay <br /> Courcy gan Joanuin Ow s mber.;f any — C <br /> and <br /> Tawnrh;p,Ranee,and 9ectlon ITS 17 I' C 7 P5-36 Minty <br /> Dla.ance from Co;ea,roads,ra;lrmdr,eac.' — — <br /> (3) TYPE OF WORK (check): <br /> New Well g] Deepening D Reconditioning D Destroying ❑ 25-90 <br /> C <br /> II destrucEmi,describe material and procedure in Item I I. 90-95 ClAy <br /> (4) PROPOSED USE (cbeck): (5) EQUIPMENT: <br /> Domestic $] Industrial ❑ Municipal ❑ Rotary Xl <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> : If gravel packed <br /> STEELOTHER: <br /> SINGLE ❑ DOUBLE <br /> Gage Diameter <br /> From '1'0 or of From To <br /> ft. it. Diam. Wall Bore ft. ft. <br /> 0 90 6 160w 11 60 90 <br /> Sae of ilme..r wdlrisi of p,-& e <br /> Dv.—be -ul Dng: e <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perl....;.n n nI 1111to nd u <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Wn uriacz a >ry real provided? <br /> Yaa30 No D To what depth 50ft. <br /> Were..... . itel agalnu pollualon? Yes D No❑ If yea,n mdepth of nr... <br /> from ft.w fo <br /> from fa. m fe Work at .. <br /> ed — 19 ,completed 19 <br /> N.thnd nr.cocas <br /> WELL DRILLER'S STATEMENT: <br /> This well was drilled under my jurisdiction and this r,Poll is true to the best <br /> (9) WATER LEVELS: nJ my knowledge and belir,f. <br /> Depth at which water <br /> was first found, ;f known ft. n <br /> illstanding level befineperfonring. ;f known ft. NAME C I <br /> (Person,firm,or corporation) (,' ped or panted) <br /> Standing level after perforating and developing ft. <br /> (10) WELL TESTS: Addresslr% <br /> Was pumv cert made? Ym ❑ No If ye.,by whom? <br /> Yield: gal./min,with 4.de.wdowo after hra. [SIGNED] <br /> (Welf Ds' .)l <br /> Temperature of water W.'.chem cal analysts made? Yea D No SI <br /> Wn alecute log made of well? Tea ❑ N tf yes ach copy License No. Pgnsi 3 Dated 1 0—n 19M <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> .>taa.190..]a 30.TRIP Or OSP <br /> DWR I8B IREV. 9.681 <br />