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DEC 2 7 1Io <br /> ORIGINAL WA-m-,cR WELL DRILLERS REPORT., Do Not Fill In <br /> File With DWR (Section 7079,7080,7081,7081,Water Cod*) <br /> N" 4Z59S <br /> THE RESOURCES AGENCY OF CALIFORNIA (o E—SK <br /> DEPARTMENT OF WATER RESOURCES � Otte e WNo <br /> Ocher Well Noy��� <br /> (1) OWNER: (11) WELL LOG: <br /> Name < Total depth .3,� ft. Depth of completed well it. <br /> Address 4 �� �Z Formation: Describe by corm,cberacler,size of walerial,and straclan <br /> (2) LOCATION OF W LL: J — 2 <br /> County / w Owner's number,if any qq .Zi <br /> Township,Range,and j4tion 1 <br /> Distance from cities,roads,railroads,etc. r _ <br /> -2— <br /> (3) TYPE OF WORK (check-): <br /> New Well P Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> It destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic Ei Industrial ❑ Municipal ❑ Rotary 2 <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. Wall Bore ft. ft. <br /> She of shoe ur wdl ring: Sac of gavel: <br /> Des ribe joint , <br /> (7) PERFORATIO OR SCREEN: <br /> Type of perforation or name of screen <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> CQNFTJ)Z�:F-Af= Lee <br /> v I <br /> (8) CONSTRUCTION: <br /> Was a surface a ary sal provided? Yes ❑ No To what depth ft. <br /> Were any zeros sealed against pollution? Yes ZI No❑ If yes,note depth of strata <br /> From fl ft.w ft. <br /> From ft. ro ft. Work started 19 Completed <br /> Method of salJng !✓ WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> of my knowledge and belief. <br /> Depth at Which water was first found, if known ft. <br /> VALLEY VJ,;TF;? WALL DRILLING & PIl^ <br /> Standing lewd before perforating, if known ft. NAME <br /> Standing level after perforating and developing ft. (Person,firm,or corporation) (Typed or printed) <br /> (10) WELL TESTS: Address <br /> I,test made? Yes ❑ No ❑ If yes,by wbom? <br /> R.L/rnin.with ft.drawdown after hes. [SIGNED] <br /> (Well Driller) <br /> Temperature of water Was a chemical analysis made? Ya EDNo El <br /> Was electric log mad,of well? Yes ❑ No ❑ If Yes,attach copy License No. 2 y� ���'� _Dated > 19- <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 1881REv 9.63) 06791.96010-66*OM TRIP 06P - <br />