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f' <br />WATER WELL DRILLERS REPORT <br />(Soctiona 7079, 7030, 7Qef, 7032, Water Cod.) <br />THE RESOURCES AGENCY OF CALIFORNIA <br />DEPARTMENT OF WATER RESOURCES <br />(1 } OCVI�TER: B <br />Name .G -'.-Y <br />"(4 •- { " •- <br />(11) WELL LOG: <br />Total depth 3. ft. Depth of completed wc11 <br />ft. <br />Address //66, ', Y <br />Formation: Describe by color, character, size of metrrid, end Fir—fore <br />ft. to <br />- ft. <br />(2) LOCATION OF ELL: 1l <br />Covnry Owner's n mb6c, iE an <br />f <br />^��. <br />AJ- <br />Tawn+hip, Aan e, nd Sec n. <br />Distance from cities, roads, railroads, ece. <br />50- J- <br />(3) TYPE OF WORK (check) : <br />New Well D( Deepening ❑ Reconditioning ❑ <br />11 destruction, describe material and procedure in Item 11. <br />Destroying ❑ <br />- 6 <br />^ (p <br />)p <br />(4) PROPOSED USE (check) : <br />Domestic <br />Domestic ER Industrial ❑ Municipal ❑ <br />Irrigation ❑ Test Well ❑ Other ❑ <br />(f) EQUIPMENT: <br />Rotary ❑ <br />Cable <br />Other ❑ <br />o- <br />go- ?I <br />1,2 . s <br />(6) CASING INSTALLED; <br />STEEL: OTHER: <br />SINGLE ❑ DOUBLE ❑& <br />Gage <br />From To or <br />ft, ft. Diem. Wall <br />If gravel packed <br />Diameter <br />of From To <br />Bore ft, ft. <br />U4 : 130 <br />;. <br />130. <br />i <br />c4OLI Z <br />` <br />33 JJ' <br />q. <br />,.. <br />Sire of shoe ar well ring: <br />Size of gravel: <br />0 .rt.. <br />N� <br />Describe joint ea I r e d IL' ;{1j + y • <br />,ft <br />i . . r'.' ":. i'•; <br />(7) PERFORATIONS OR SCREEN: <br />Type of perforation or name of screen <br />J <br />t',• <br />J -• '1t, <br />s.. <br />From <br />ft, <br />To <br />ft. <br />Perf. <br />per <br />row <br />Ro s <br />per <br />it. <br />Size <br />in. x in. <br />- <br />�e <br />.96J <br />of 49 <br />.? ' <br />dl <br />aroY <br />t <br />A. _ <br />f 17 <br />is'l <br />-, <br />& i <br />(8) CONSTRUCTION:y <br />Wu a surface uninryseal provided) Yea x No ❑ To what depth Q fc. <br />— 3 <br />S 1 •etlWere <br />an strata sealed a aiast pollution? Yea r No <br />y ] ❑` <br />If qts, note depth of ttnn <br />C a.' <br />j T- Q h <br />'t <br />From SU .. fc. r. 58 fr. - tai . <br />?"L <br />p <br />From ft. to • ft. <br />- <br />Work started: l9 ', Completed <br />Method of aealin ,i f : �'..h�,r..ti'' <br />WELL DRILLER'S STATEMENT: <br />This well was drilled asffder my jurisdictiox,and Ibisireport is <br />Of my knowledge and be&ej <br />-NAME <br />(Person, firm, or corporation) Typrd'or print <br />Address <br />true to tbee,bes <br />(9) WATER' LEVELS <br />Depth at which water tas scat found, if known ft. <br />Seaaelin6 level brfon perfontidg, if It— G` fr, <br />Standio 1-.1 after p-f.,ar;.X and devdo in - - ft. <br />(10) WELL:.' TESTS: <br />Wu um test madei Xn No <br />p ClIf es,b wbonaT <br />�,• to �, <br />r" <br />y <br />Yi.ld: aal.fmin, with it. drawdown after fin, <br />nn <br />_[SIGNE11]_A�4,tj. _'?I1l :r-• <br />r <br />Temperature of water Wu . chetalnl end air made? Yea Q No ❑ <br />Was electric log made of will} Yu [] No/ r ) <br />fid tf Ya, .trach cope License No.,( r�. n 'd . Dated- 9— <br />SKETCH LOCATION OF WELL. ON REVERSE SIDE <br />DWR 188 (REV, 9-05) - 'n `} U 7 06391.93010.93&amTatip Ao! <br />