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<br /> RALL' STATE OF CALIFORNIA DO 1t0)t fill tf7
<br /> IGIN �,^ THE RESOURCES AGENCY
<br /> i!e Witli"DWR DEPARTMENT OF WATER RESOURCES No. 45023
<br /> T ce ointent No.;- WATER WELL DRILLERS REPORT
<br /> orif State Well No.
<br /> al Puinit No. or Date Other Well No.
<br /> 'VNER:' Nam _ (12) WELL LOG: Total depthLI�Lft. Depth of completed w.14—at/ ft.
<br />�ddress from ft. to ft. Formation (Describe by color, character, size nr material)
<br /> i A-11 - Zip — -D 11
<br /> (2)
<br /> LOCATION OF-WELL (S,, instructions):
<br /> unh• T n Owner' .Well]umber —
<br /> e11 address if diffegent nm above Q
<br /> Township Range ctio - IV
<br /> J
<br /> istance from cities• roads, railroads, fences, etc.
<br /> (3) TYPE OF WORE:
<br /> New Well S. Deepening ❑
<br /> kA Reconstruction ❑
<br /> Reconditioning �]
<br /> a
<br /> +�1 0 �;' }y,�[ Horizontal Well
<br /> u, r
<br /> Destruction ❑ {Describedestr �1
<br /> procedures
<br /> materials d XM in Item
<br /> (4) PROPOSED
<br /> Domestic
<br /> Irrigarioa�� — V
<br /> Industrial O ❑
<br /> t 'Well ❑ -
<br /> !,t
<br /> t
<br /> Dfunici —� \
<br /> WELL LOCATION SKETCH Other ❑
<br /> \J
<br /> (5) EQUIPMENT; (B) GRA PACK-
<br />'to El© Reverse ❑ No Size \C
<br /> Gable Air ❑ ter of bore —
<br /> Other ❑ Bucket ❑ rom —
<br /> 7) CASING INSTALLED (8 PERFOR 'S:
<br /> Leel �$, Plastic ❑ et Type of pe nn o 'ze of scree
<br /> From T Dia. r F To
<br /> ft. f. in. Wall ft. S'
<br /> 1 —
<br /> V9) WELL SEAL: D surface sanitary seal provided? Yes No ❑ If yes, to depth---
<br /> Were —
<br /> strata sealed against pollution? Yes ❑ No ❑ lnten•al —
<br /> llethod of sealin Work start 19 Complet 19
<br /> 10) WATER LEVELS: WELL DRILLER'S STATEMENT:
<br /> wroepth of first water, if knowr ft. This well war drilled under my jurisdiction and-rhis report is true,to the best of my
<br /> Standing level after well completion/- ft knowledge a belief.
<br /> lI) WELL TESTS: SIGNED
<br /> (Well. Driller)'
<br /> pe'as well test made? Yes ❑ No [3 if yes. by whom9 luof test Pump ❑ Bailer [] Air lift ❑ Nf11\Z
<br /> Depth to water at start of test _ ft �AtFOO of test. ft �(erso firm or corporation) (T or p ted
<br /> I-, it;
<br /> Address `f
<br /> Discharge galyrnin after —ours Water temperature
<br /> len-ical analysis made?" Yes ❑ No ❑. If yes. by whom? City p
<br /> > = , to
<br /> this
<br /> report License A'o. ate of this repo'
<br /> -c log made. - Yei (]-• - Ao ❑ If> attagh copy
<br /> a6 tgEv 7 gal IF ADDITIONAL qAP k-EZI5,NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM .s*+saso> rseow auwaOrosr, 4
<br /> Y.
<br /> tint sa• 5
<br /> 4•,^ M d L "., fit'. 'N'.'
<br /> ' _'� 1' -- - na J•�. .� y�Y r 7 7 art 4 + r i � t� ��.
<br /> Y.,•,w-
<br /> .� t �' 3 � .?,� ra' 1-..•�, �+ t" _ `.s i t .k c,r + �� �? t'_ 12� ct. C'. n 3`.�,� -
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<br />' — � - a _ Y3" tr i � /. NM,.r=;,ate? „{ r ;r' � � I.r" rt :'?•ly � :i' ',s..
<br /> .�fr. s�� S��*!' k{t,��7.� �l.'s dS3'�tom,r: ��u\�-`^ ^}. 4 .yY''. :-i �a.�,�..�it �a�• ,.s _��{�rS�i'� •��" F ~}dy,*e`ly�r w" •i rayys r'�J�n A"�°f'�Fs�-w�{a4:�
<br /> c, r �;i._.�*.-.w�pvy...,f�Fi�`'t•�?� d� .+t. ((_t'._x,r. �1 ,l. �. rJ'f;,�'��C �a ) �Ka-'ti � � 4�;�T���'y';1� 1-a+li -'{4 �:Y�S^' f.��•Z v�'Se�
<br /> -- .F. .^G�;�'+r�, ah ,yy:�t+�,„i"'' s-f�l.��,:..�r� ��.+�? C����y��'. �y'� r4i?`'ij�3';i�;T I'�a♦ r.`s'V��Sr.�'-t����- �•� =,�-�a.?�+r'3;. 3' -.;f-.,'art ".�...5'd,i..�.
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