Laserfiche WebLink
ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> File with VWR ($eetrnna 7079,701101170111,7092,water code) N? 23584 <br /> THE RESOURCES AGENCY OF CALIFORNIA ; — <br /> �r DEPARTMENT OF WATER RESOURCES State Well No - <br /> (1) OWNER (11) WELL LOG• <br /> Name ! Total depth 3 Z <br /> it Depth of completed well it <br /> Address q0 ormation Describe by cofp rbsrrrter asze o/tnaterua aatd 1tr1Frt1$" <br /> . 7f— it so it <br /> (z) LO ON OF WEA <br /> Count1 tier a num6ar rf any <br /> Township Range an unn r '57 <br /> D"tan ram canes roads railroads etc <br /> J) TYPE 45F WORK (check): �ZAt d ,a <br /> New Wel! ❑ Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> It destruction,describe maternal and procedure in Item 11 <br /> (4) PROPOSED USE (cbeck). (S) EQUIPMENT: <br /> Domestic 0 Industrial ❑ Municipal ❑ Rotary 9 <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL OTHER If gravel packed <br /> SINGLE DOUBLE ❑ <br /> Gage Diameter <br /> From To or of From To <br /> ft ft Diam Wal! Bore ft. it <br /> Saze of shoe or well ring S.ze of xrsvel I row r-1 Ot <br /> Describe loan[ ,�2C 1'''5 <br /> 2 p(7) PERFORATIONS OR SCREEN <br /> Type of perforation or name of screen <br /> Perf Rows <br /> From To per per Size <br /> ft ft row ft to x an <br /> (8) CONSTRUCTION. <br /> Was a rarf-c-aan,ta[ <br /> y seal provided[ Yes No ❑ To what depth / r.1 it <br /> Were any strata sealed against palEpnana los No❑ If yes note depth of strata <br /> I rom it to it / <br /> From ft to ft Work started 19(p Completed 19 <br /> gg <br /> Method of sealing { WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS Thu well was drilled under my jurisdiction and this report is true to the best <br /> of my knowledge and belief <br /> Depth at whach water was first found of known it <br /> Standing level before perforating if known ft NAME <br /> Standing level after perfOratIng and developing it (Person,firm or corpprataon) (Typed or prrnird) <br /> (10) WELL TESTS Address/E7/ &4ef: /g E� O S <� <br /> p test made? Yes No 1!yes,by whom? /y <br /> gal/tnrn with it drawdown after 6ra (SIGNED) G'C <br /> Drafrr <br /> Temperature of water Was a chemical analysts made? Yo (Tela❑ Na � r � �-////���[[. <br /> Was elertrrc log made of well) Yes ❑ No If yet attach copy License No :3 at r— , 19-s� <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 168 (REV 9 65) 11/210i 95D to as soM Tg1P(DA oar <br />