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' STATE OF CALIFORNIA Do Not F:II In <br /> ORIGINAL THE RESOURCES AGENCY <br /> File with IdWR DEPARTMENT OF WATER RESOURCES N2 14 718 6 <br /> WATER WELL DRILLERS REPORT State Well No _ <br /> UJ f'1 Other Well No 7 42 0 F-2 <br /> (1) OWNER <br /> (1 1) WELL LOG <br /> Name <br /> ' - • • �� .1 it Total depth a r^ ,� <br /> Address — ft Depth of completed well !t <br /> =1 - <br /> .. Formanon Desrrrbr by.olor rherarler srae o/wattnal acrd strurtnre <br /> ' J fs to ft <br /> (2)-LOCATION OF WELL <br /> t_4univ �' n <br /> Owner s number if am � <br /> Townsh.v Rang, and Section <br /> D...an-from cites roads railroads erc _ �' 'ice Il �„ J - 12 Z <br /> (3) TYPT <br /> E OF WORK (check) 3 — <br /> ' <br /> ' New Well_C1 Deepening El Reconditioning �p❑ Destroying ❑ � y� j G _ <br /> If destruction describe material and procedure in Item 11 <br /> (4) PROPOSED USE check (S) EQUIPMENT �'r <br /> Domestic [2 Industrial Municipal ❑ Rotary <br /> Irrigation:S Test Well Other Cable <br /> Ocher � <br /> (6) CASING INSTALLED <br /> STEEL OTW ER If gravel packed <br /> SINGLE Q DOUBLE ❑ <br /> Gage Diameter <br /> ' Froin 10 or of From To <br /> ft [t Diam Wall Bore ft ft <br /> lb -ze sit>hoe..r wrl[nnK i rY L';` Sire of eravrl <br /> llcacri br Dins "�I r i�� <br /> (7) PERFORATIONS OR SCREEN- <br /> Type ul pert—t—,or name of:erten <br /> Peri Rows <br /> From To per per Size <br /> ' ft ft row ft to x in <br />' (8) CONSTRUCTION <br /> Wu a aurlace--31V seal provtdedI Yrs ❑ 'No ❑ To what depth It <br /> Were anv .rata scaled aRatmt pollutions Yes ❑ No L if sea ..it depth of,vara <br /> From ft to ft <br /> From ft to ft 'l-'4 47— c+ <br /> Work Started 2) ]9 I Completed G 19 J <br /> method of du[inq <br /> WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS- JJ This well was drilled under my jurisdiction and this repurt is trete to the best <br />' Depth at which water was first found if knownft <br /> ref my knowledge and belief <br /> Standing level before perforating .f known ft NAME tJ e-.1 -12'I-,1 <br /> >randrng level after perforating and develo inq ft (Person firm or corporation) (T)ped or emoted) <br /> (10) WELL TESTS Address �' , TT '_ A 1,c: <br />' Was pump test mads Yes ❑ No ❑ If yes by whom) <br /> JJr Yield Ral/min wirh ft drawdown after <br /> hes (SIGNED] <br /> Temperature of water Was a chemical analysis made° Yrs ❑ No Q (Well L)rrlfrr) <br /> Was electric log made of well? Yes <br /> ❑ No ❑ If.es attach copy License No Dated L � <br /> jy 1 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 168 [REV 9 681 <br /> 4 e 72 94M TRIP(Dr OSP <br />