Laserfiche WebLink
)P-J- INAL STATE OF CALI FOR N IA <br /> `File with DWR �� THE RESOURCES AGENCY% DO not fill {ii <br /> J <br /> DEPARTMENT OF WATER RESOURCES N0.29228 <br /> nt«e..f Intent ,. 'WATER WELL DRILLERS REPORT State * _. <br /> �ortt i'ennit Nn. or Dnte We1L No. <br /> f <br /> ! Other Well N <br /> 1 <br /> 1, OWINER: Name <br /> tldre-.-, 't='• t 12) WELL LOG: Total deptlt"ft. Depth t,f completed well_e <br /> ft. <br /> i... fn,rn ft. to It. X',no:riiuu (Describe by c„ior, cBar'acter, sizr ur material) <br /> City <br /> Lip <br /> , I-QQITIQ>r OF WELL <br /> (5ee instrtictions): C� cam. <br /> ",mry Owner's Well Number <br /> address if ere t fro , OveRalaf <br /> Section <br /> )isttn¢e from cities, ruads, mllmads, fences, etc. <br /> (3) TYPE OF WORK. <br /> New Well Deepening [] <br /> ' Reconstruction _ <br /> Reconditioning <br /> Horizontal Well <br /> Destructiun ["I (Describe <br /> destruction materials <br /> procedures in Item <br /> 1 e,,c (4) PROPOSED4�j3 <br /> ,. <br /> Domestic <br /> zX Y <br /> Industrial <br /> Test Well <br /> Stock\\ <br /> ,'l <br /> +r' <br /> WELL LOCATICIff SKETCH Other /� ❑ HT1, <br /> 2.i 1 EQUIP.-. T: (6) GRAS' ,PACK: <br /> 10t.', [T(/ Reverse [] Sgs \'oC] SxeLTable i <br /> El Air air ❑ L! ter <br /> �ter of bore <br /> Other +`? 7 to <br /> L� Bucket ❑ Packed rom <br /> 71 CASING INSTALL D ♦ (8)-PERFORATIONS: - <br /> {�teel L] Plast [ C60ret&\L,� Type of per t%'hpn oi\itize of screery;:Z�\ - <br /> Froin To— Dia. 20r Fret`- To $)t)fv <br /> ft. fi'-- in. Wall pt ft. ^�'''�sizm <br /> �If <br /> :9) WELL SEAL: <br /> k -/ <br /> `Vas surface sanitary seal provided? Yes R` Nn.i If yes, to depth 60 ft. <br /> Were strainsealed against ollutio 'Yes ( No C] Interval ft. - <br /> 1lethud uI sealinr Z W,,rk started I9 CampFet 19 <br /> Lr.10) WATER LEVELS: WELL DRILLERS STATENIE,vT: <br /> Depth of first water, if known ft. <br /> This well was drill <br /> n,uler ny ja ris[fict:urt ( this rePnri is irnc to the hest of my <br /> up <br /> Standing level after well cm letiva - It. knowledge or e1' f. <br /> (I;) WELL TESTS: StcN�o <br /> ryas well test made? Yes " No �f yes, by -horn? (Well Driller) <br /> ` <br /> Type of test Pump V Bailer ❑ Air lift ❑ NAN,IE <br /> Depth to water at start of test ft. At end: of!tesft r corpora <br /> Discharge gal/min after -:hours Water temperature Address <br /> L.Chemical analysis made? Yes a -No �f ves, by whom? 0 <br /> 1'' -lettric I" made? Yes C \o ;__11r ties, stiach copy to Ihu report I.icezue No �`` r,Date of this epo <br /> C. , 188 (REV. 7.765 IF ADDITIONAL SPACE IS'NE'EDED. USE NEXT CONSECUTIVELY IW1GOB�' iF dM y43i?A�47-76 Sona cva.a--7 OSP <br /> — T. <br />