Laserfiche WebLink
STATE OF CAUFORNIA <br /> ORIGINAL THE RESOURCVS AGENCY - Do not fill to <br /> • rIle with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 339228 <br /> of Intent No. State Well No. <br /> Local Permit No,or Date / .�a�`S --�� Other Well No <br /> (1) OWNER Name (12) WELL LOG Total depth ft. Completed depth ft <br /> Address S. 0 from ft to ft. Formation(Describe by color,character,size or inateri ll) <br /> City ZP 0 _ <br /> (2) LOCATION OF WELL (See instructions) f <br /> County Owners Well Number M14-2, - Q ( ++ <br /> Well address if differe t From above Q <br /> Township r1_Range /Z b t=_ 5eetion. - <br /> Distance from cities,roads,railroads,fences etc 0J' <br /> ` �� I(3) TYPE OF WORK � akzk L <br /> �t�'— n, 1 New Well f] Deepening ❑ <br /> t , 11 <br /> Reconstruction ❑ 14 Ll "' Lrq S <br /> i Reconditioning ❑ <br /> I ! R'Honzontal Well ❑ <br /> Destruction ❑ (Describe k- fle <br /> Idestruction materials and pro- <br /> cedures to Item 12) <br /> f q (4) PROPOSED US <br /> Domestic - <br /> �' 'Irrigation <br /> Industrial ❑ <br /> l I` Test Well ❑ - <br /> '1 1 a� ,'b Svluntc� l ❑ - <br /> 0 <br /> WFLL LOCATION SxF7rCH <br /> (5} );QL7IPMENT tAV L, CIG <br /> Rotary ❑ Revem ❑ NoCable ElAir ❑ f boreOtherVb Bucke rom At tv - <br /> ul - <br /> (7) CASING INSTALLED (8) PEIi O Tl Q <br /> Steel ❑ Plasue t Ty of f on or size of - <br /> From T � Gage or t <br /> ft f i Wall size <br /> D S — <br /> r i <br /> (9) WELL SEAL. <br /> Was surface sanitary seal provtaeda Yes No❑ If ye;indepth <br /> �_j IL — <br /> WarestratasealedagatnstpogationP Yes ❑ No ❑ Interval__ ft. <br /> Methodafscaling Work started I9 Completed - ' If} <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of f nt water if known f L This well was drifted under my Turk fon and this report Is true to the <br /> Standmglevelafterwellcompletion b ---fL best of rity krt 19 <br /> Iedg nd f <br /> (1I) WELL TESTS signed <br /> @Eos well test made? Yes❑ No� If yes,by whom? Well Drdler) <br /> pthpto water at start of testi a PUMP ❑ ft AaUcr © At end of test u bit ❑ ft NAME {Pr n,ftrm orcor ry Ion}(T printcd) <br /> • Discharge gal/min after hours t•vatertempernture Address .y(f <br /> Chemical analysis made? Ye3)W0 No ❑ If yes,by whom? City f-WiAte, zip <br /> Was electric log made Yes-13No Ifymallochcoytothareport Licem- Date of Ibis re rt_...�Z�6r <br /> DWR 788 GIUV 12-a% IF ADDITIONAL SPACE IS NEEOLD USE NEXT CONSECUTIVELY NUMBERED FORM 963M <br />