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STATE OF CALIFORNIA Do Not Fill In <br /> DUPLICATE THE RESOURCES AGENCY <br /> Retefo the copy DEPARTMENT OF WATER RESOURCES N2' 155278 <br /> WATER WELL DRILLERS REPORT State Well N.—`7 07 4i <br /> Ocher Well No. <br /> (1) OWNER: (1 f) WELL LOG: <br /> Name -)08 Total depth 08 `28 <br /> ft. Depth of oompl.red wal it. <br /> Address •-.1,L.^ °.i Ort s.ay Formation: Deo-ria by to,,,h....tena of marend,.nd n..rrme <br /> '�-3 ., <br /> fr. 1 opsoil <br /> (2) LOCATION OF WELL: <br /> C....ymher if v_ n <br /> _I k. nY <br /> Township.Range,and secti _. „ o r tnu '; <br /> n no <br /> Distance fronada,oulmods.tot. ir a Ali south - i - <br /> aa:.t side -( _ n ; <br /> (3) TYPE OF WORK •(check): 71 <br /> New Well CZ Deepening ❑ Reconditioning ❑ Destroying $ <br /> Ma Ire <br /> If destructdon,describe material and procedure in Item ll. --f' n- <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: `-- 1 , <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary EBF --'o 6r n <br /> Irrigation , Test Well ❑ Other ❑ Cable ❑ '— `' - n; <br /> Other ❑ — :,na <br /> (6) CASING INSTALLED: 112—159 ay <br /> If gravel packed J I— -- u - .'fir <br /> STEEL OTHER: <br /> V— t.'i' -_an <br /> SINGLE DOUBLE <br /> _ tic � .;:Iy <br /> Gage Diameter179-195ban <br /> From '1'o or of From To <br /> ft. It. Duro. Wall Bore 19'—Zoo ay <br /> 16 W 20 2 band <br /> 2 21 -71�. ue c lay <br /> 23b ,.an <br /> ae of,hoe r weu ring: ae of e vel: bird seve 2 -2 aY <br /> 2 .ana c:_ grave <br /> (7) PERFORATIONS OR SCREEN: —30 ue C `ly <br /> Type of it r of sc en LOUVeredCr: Ful—f l O <br /> Pref. Rows <br /> From To per per Size <br /> it. ft. row ft. in.x in. <br /> u7.-f to <br /> 48 1 i_„ 1 x 2-,,-0 <br /> (8) CONSTRUCTION: <br /> Was a wriace s.niury seal provided? Yet ❑ ist. LX To what depth It. <br /> Were any sans sealed iteur n,p.11 ri.r? Ya, ❑ No❑ If yes,nom depth of...au <br /> From it.on A. <br /> From IT. m it. Work started —U 19 .Completed 19 <br /> Method of aeaGnA WELL DRILLER'S STATEMENT: <br /> This <br /> �rmunder my jurisdiction and this report is true to the best(9) WATER LEVELS: D/mykeledgeand belief <br /> Depth at which war,raa fires fon.d, if known It. - <br /> 9andimg le.el heforetest ..on, if krim— It. NAME 's3 rot, ! r111.�:: • �TnC• <br /> Standing level after perforating and de.elo ing 10,2 it. n(Per on,firm,or eorpmaaian) (Typed prp.inted) <br /> (10) WELL TESTS: ll++ [� Address 2 500 -umble <br /> Was pomp t made? Ye. ❑ No [I If'r'.bE whom? r •U `C E• ':O e- "O ", — • _ l <br /> Yield: A.L/min.with � cdrawdsi_fte. 1 hrs. [SIGNED] <br /> Temper of-.,a, Was a chemn <br /> ical.m lyu made? Yes ❑ No OX (Well D.:11 <br /> -10 <br /> Wmelec clog made of well? yet [I No EIX Ifyen ach copy License No. 29nSl3 76 Dared 19 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR IBB (REV. 9-681 a-fa HOM TAIp Qr CmI <br />