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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 2 R 101 1 .l f <br /> i- <br /> �e of Intent No Y ite\A'(II No <br /> Local Permit No or Date Othcr \\ell No r �'�y`�`�� — <br /> (1) OWNER Namu. 4AS (12) WELL LOG Total deptli 5 -- ft Completed depthZ ft <br /> Address from fl Io ft Formili(m (Describe bt color character We nr material) <br /> City ZIP _ <br /> (2) LOCATION OF WELL (See Instructions) — Q <br /> Count. Owntr s Well !umber <br /> i <br /> NNell address If different from above — <br /> ToN nship 1�,e _� Range-Ag-E -_ Section Z Z <br /> Distance from sales roads railroads fences etc <br /> t � <br /> (3) T1 PE OF WORK — <br /> New Well A Deepening ❑ <br /> Reconstruction ❑ — �,v` <br /> Reconditioning ❑ — <br /> HUTILontal Well ❑ t <br /> Destruction ❑ (Describe <br /> destruction materials and pro- - <br /> cedures In Item 12) _ <br /> (4) PROPOSED USE <br /> Domestic ❑ _ _ <br /> Irrigation © _ <br /> Industrial — ❑ _ <br /> Test Well © _ <br /> Municipal © _ <br /> Other _ <br /> WELL LOCATION SKETCH (Describe j _ <br /> (5) EQUIPMENT (G) GRAVEL PACK <br /> Rotary ❑ Reverse ❑ Yes Na C1Stu — <br /> Cable ❑ Air Elr Iliameler of bort N <br /> Oth(r Bucket__❑ Packed from__!9_ to fr <br /> (7) CASING INSTALLED (8) PERFORATIONS <br /> Steel ❑ Plastic nerwt6l El Typy of perforation or size of <br /> From T iA Gage or '—pr'01n To ! slrit <br /> ft ftA t' Wall ft - r ft size <br /> Z <br /> — <br /> tn <br /> (9) WELL SEAL - <br /> 'Alas surface samtars seal provided? it sxi No ❑ If)es to dt pth_ft — <br /> WCtL strata sealed against pollution 0 lee No)< ln(Ln i ft -» <br /> Method of sealing 4\ori,started —192M C ompleteci 3 15 <br /> (10) WATERLE\TEES WELL DRILLERS STATEMENT <br /> Dtpthoffirst water 11known Z s ft <br /> 5tandmghvelaEttry.ellcomplettnn [t 7hls aril] tray clr d rnJW, jrrrtyrltrlwn and clan rclrurl rt tiro to !ht <br /> Le%I of rut kno a nn h <br /> (11) W ELL TESTS <br /> Was well lett madeP les Stg,nt d <br /> ❑ NiNo lE),�s h�yy bulli (W,II ihdh r-rf <br /> etfoest Pump ❑ Radcr ❑ Airlift ❑ NAAAL w ater at start of test ft At end of It st ft -2 LJ (P son flanart ratinn)(Typed nr ted) <br /> Diwh3Tg( gal/min aft,r hours Water iem <br /> ru1WEr Curt A(i( [ss <br /> (hercalanahsismadt� les x No� lfye% h)whnm +�V n 7.fP q*51r.B! <br /> Was electric log malt l es ❑ No If yes altar h copy in this report l is(use NoDit( of this rt port <br /> DWR 186 (REV 12-86) IFA DITIONAL SPACE IS NEEDED USE NE%7 CONSECUTIVELY NUMBERED FORM 86 96355 <br />