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P <br /> i + , <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY :S Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> (� WATER WELL DRILLERS .REPORT N4. 257122 <br /> l I' State well No. <br /> tee of Intent No. Uj!/CG_O <br /> Local Permit No. or Date ;, Other Well No. <br /> (1) OWNER: Na e o e— T It (12) WELT' LOG: Total depth ft. Completed depth Sat <br /> i <br /> Addre- Z from Ft. to ft. Fermi tion (Describe by color,character,size or material) <br /> C5aN <br /> ity ._._ <br /> (2) LOCATION OF )V�LL (See instructions): <br /> Cuuntlr3 � ut !V O�vreer's Well Nun r <br /> Well address if diF erent from alxrve E FYGutN &.S 01_51k '` `�` �jt1 t►D►a'-� <br /> Townshi � '" Range -7 Seciion -i�s,� ?ri�� 6rr�w+� <br /> P _ <br /> Dist. cr f rim cities,roads, railroads, Fences, etc. <br /> 5r. 3a.� = S�' _ vows t <br /> 14 <br /> CIT- (3) TYPE OF WORK: <br /> / <br /> 1 �` New Well 6d Deepening ❑ � y' <br /> 4 �O _„1 N Reconstruction ❑ \ <br /> t <br /> Q-� v> <br /> Reconditioning ❑ \v <br /> - Q Horizontal WellPl- ❑ — \\ �` <br /> to <br /> � Destruction ❑ (Describe ` <br /> destruction materials and pro- <br /> Q cedures in Item 12) \) ) y <br /> (4) PROPOSED US A .v <br /> Domestic _ �_ `/ '� � <br /> Irrigation <br /> \` ^_ <br /> Industrial ❑ <br /> Test Well ❑ \ �� <br /> Munici I� \"`���''' ❑ /' <br /> WELL LOCATION SKETCH ( ibe) <br /> (5) EQUIPMENT- 6l GRAV AACIi: - �/-' `✓ <br /> rr,�.. ��� <br /> Rotary�1 �V Reverse ❑ � No`L1 ;Siz4t <br /> Cable ❑ Air © \ Vete of bore 1� � '• I� <br /> Other ❑ Bucke f <br /> (7) CASING INSTALLED: -` \ i 'i (8) PESFOB TIONS <br /> Steet ❑ Plastic Typeof Dr size of sero Q\-�' <br /> From T i . Gage or ` Ta' <br /> ft. f, i Wall t� size _ <br /> — <br /> (9) WELL SEAL: f -' <br /> Was surface sanitary seal provided? Yes No ❑ If yes,to depth <br /> Were strata sealed amst pollution? Yes [__1 No [I Interval It. - <br /> Method of leafing t Work started-Z-1 _19Completed Z- 19 <br /> (101 WATER LEVELS: WELL DRILLER"S STATEMENT: <br /> Depth of first water,if known ft. i` <br /> Thi well was'. le i+ dictf is report is true to the <br /> Standing levet after well completion ft. best of my uu e u li <br /> 0 <br /> (i;1) WELL TESTSm : 5+geed <br /> Wwell lest made? Yes ❑ No If y es, � <br /> b barn' }` o }�nller <br /> M�f Int Pump Cl by <br /> ❑w Air lift ❑ `AMS I �I(�( Iry _ <br /> ln to water at Start of test ft. At end of test ft. �i r (Per n Sn,�,r u,rpor ti ny I or pri Wed) <br /> %'-_.«harge gat/mina er hours Wate emperatuLe Address <br /> (:hemicaf analysis made? Yes No ❑ f yes,by whom? C' ,/t-A *4 City V_�p_� ZIP <br /> Was electric Ing made Yes ❑ No If vet,attach copy to this report License No. Z ii✓�'0 Date of this report <br /> DWR 188(REV. 12-86) IF ADDITIONAL. SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 94355 <br />