Laserfiche WebLink
QUADRUPLICATE STATE OF CALI FORN I A <br /> Use of comply with THE RESOURCES AGENCY Do not fill in <br /> localrequiremeefs DEPARTMENT OF WATER RESOURCES No. 168986 <br /> N„lice of Intent No. WATER WELL DRILLERS REPORT State Well No.-- <br /> I,,cal <br /> o.I,real Permit No. or Date c &570 Other Well Nn. <br /> ( 1) OWNER: Nam 12 WELL LOG: 157 14`0 <br /> Total depth ft. Depth of completed well ft. <br /> Wd.Is <br /> 44W E. Pe= v, �� Ecom ft. to ft. Formation (Descri by color, haracte , we or material) it <br /> IA ct0rat3:rr.cia • Zip - • f <br /> (2) LOCATION OF WELL — <br /> (See instructions) it <br /> Cmmty+sK+ s)•08gI21fl Owner'.Well Number <br /> Well address�if�.aatem different from above25791 ba 1 - _ <br /> 'township layRange64 73 Sectio _ _1.. <br /> Distance hnm cities, mads, railroads,fences,etc 14' 90 <br /> = <br /> (3) TYPE OF WORK:New Well a"Deopening ❑ _ --- ' ---_-_. _ _... ....r__._ ... <br /> Reconstruction ❑ — <br /> Reconditioning ❑ - <br /> Harizontal Well ❑ - <br /> Destruction ❑ (Describe - <br /> destruction materials and <br /> procedures fn Item 12) - <br /> (4) PROPOSED USE: - vy <br /> Domestic x7.V - <br /> Irrigation ❑ - <br /> Industrial ❑ - <br /> Test W,11 ❑ <br /> Stock ❑ - v <br /> Municipal ❑WELL LOCATION SKETCH I Other ❑ <br /> (5) EQUIPMENT: (R) GRAVEL PACK: - yJ <br /> Rotary Reverse ❑ Yes Z� No ❑ Sua, <br /> Cable ❑ Air ❑ Dimneter of bore 1.2 - 1_ <br /> Other ❑ Bucket ❑ Packed from n 1 moi' k �. <br /> 17) CASING INSTALLED: (B) PERFORATIONS: - 1 <br /> Steel ❑ plastic Q' Cnnarete ❑ Type of perfnratiun or size of screen <br /> From TO Dia. Gage or From To Slot <br /> ft. ft, in. Wall ft. ft. size - <br /> 0 140 S 160 120 1i - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes:�jl No41”:If yes, to depth 50 ft. - <br /> Were strata sealed agaimt pug_ Ilgtinn?s yYes ❑ No ❑ Interval H. - , <br /> Method of sea' 27FYiTiH LLLv Work started 19_ Complet d 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if kno ft. This meal mos drilled under cop jurisdiction and this report is true to the best o} cop <br /> Standing level after well completio ft, koomledge and belief. f i�I.in.>Ta <br /> (11) WELL TESTS: SIGNED - � �.�✓may!. -'r <br /> We well test made? Yes ❑ No ❑ If yes, by whom? 1,c 1,4,k'j{]c�' y�,I,i�)l]Je f 1114`♦ <br /> Type of test Pump ❑ Bailer❑ Air lift ❑ NAME <br /> Depth to water at start of tm ft. At and of fest w mtioa) (Typed or printed) <br /> Discharge nal/min after hears Water temperatute Address ry�yjrt�,i^.,r._'(3' 13 �73� <br /> Chemical analysis made? Yes ❑ No ❑ H yes, by whom? <br /> Was electric log made? Yes ❑ No ❑ If yes, attach copy to this report License No. Date of this repo <br /> DWR 188 (REV.rom IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />