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4r <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> +-r ; WATER WELL DRILLERS REPORT N0. 257123 <br /> E <br /> :ce of Intent No. State Well No. � 1 <br /> Lcxal Permit No. or Date Other Well No. <br /> (1) OWNER: Name fl-e- �' ���� (12) WELL LOG: Total depth 6°p ft. Completed depth �' ft. <br /> :Address I Z � front ft, lu ft. Formation (Describe by color,character,size or material) <br /> City ..-S t�� �Q7 S E G ZIP`ars <br /> (2) LOCATION OF WELL (See instructions): <br /> CountVS!'jj�_1 : 6 QUA I tJ Owner's Well Numr <br /> Township S'T' s <br /> Welk address if d�ifJRang �-y r <br /> ferent from ahnve r 10 r0#4, <br /> i.w 1 '" a t Section <br /> Distance from ties, roads, railroads, fences,etc. sihf <br /> a,. rz, /Wa - <br /> 5� (3) TYPE OF ORK: — <br /> .f— New Well Deepening ❑ _ \ <br /> Reconstruction ❑ <br /> d Reconditioning ❑ �✓` <br /> cn % <br /> c Horizontal Well ❑ <br /> V F Destruction ❑ (Describe <br /> destruction materials and pro- <br /> - cedures in Item 12) <br /> (4) PROPOSED U5 <br /> Domestic _ J <br /> Irrigation <br /> Industrial ❑ _, s 06f <br /> �.+ Test Well R J ❑ �1 ✓ <br /> Munici6af\ ❑ <br /> Okber 1rLii, <br /> �,. WELL LOCATION SKETCH y <br /> (S) EQUIPMENT: AG �GRAVEL Pa CK. <br /> RataryWL.(r{GI/Reverse ElYrs l� No'l� �.Sizte ' -01 <br /> &W Cable Ll1 Air C1ia�ite`te�ot bore i t <br /> Other ❑ Sucke;- ed from Z 7 a.0—f.. <br /> (,) CASING INSTALLE"}D:�/ V `i t (8) PERF0RATIW: <br /> G. steel ❑ PlasticLtd efe TyMof] Eoi��ion or size <br /> 1 . <br /> From Dia. Gage or <br /> ft. ftp r 1WI Wall \\u <.,k — <br /> (9) WELL SEAL: <br /> Was surface sanitary seai provided? Yea v No 0 If yes. <br /> - <br /> s f <br /> to depth—=--ft. <br /> Were strata sealed;Ks <br /> inst pollution? Yes ❑ No•� Interval f — <br /> Method of sealing ` �r ��'�� «rorkt started C' 19Completed t" 19 ' <br /> +-. (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft. <br /> Standing level after wellcom letion Q ft. best u'c!l was drilled under nit jari- iclion ort is lruE to the <br /> g p Desi of my kno ' nd <br /> (11) WELL TESTS: Signed <br /> Was well test made? Yes ❑ No If yes,bo wh-m1? (Well DrCer]., <br /> of test Pump ❑ Bailer ❑ Air lift ElNA VIE 1L\1 l-14 41—t W e LL— '> 1�—i L.L-1 t'4 C , <br /> r <br /> ' t i to water at start of test ft. At end of teat ft. I rw arm,or arpo ran}(Typed ur printed) <br /> gal;min after hours Wat temperatur Address 1' ` �,5 <br /> v � CoNC�Q.D Gr9 ZIP 5l$ <br /> Chemical analysis made? Yes No y❑ If yes,by whom f e �t ifiy <br /> Was electric log made Yes © No Fd lE yes,attach copy to this report License No. Z Date of this report Zj (''R 9"? <br /> DWR I"(REV. 12-861 IF ADDITIONAL SPACE fS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 M315 <br /> i.r <br />