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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES N2 94639 . <br /> { Fil:e♦vith DWR <br /> *: WAT". it WELL DRILLERS REPORT Stare Well No. <br /> 0dicr Well Iia I <br /> L (I) OWNER: (1 1) WELL LOG: <br /> i <br /> I <br /> Name 1 _4 U r n z poi r �t�] S F,r V 3.r � T.,rzl denrh fr. nrpeh of complerra xrll it. <br /> Address I r 1`ornsa[for:: Iln:->ibc by rotor,eharacrrr,rice a}mere riot,enJ rn urfurr <br /> _ i tsazk t n n, A 9 5 2 0 5 f ra fr_ <br /> L (2) LOCATION OF WELL: nWPI ] 1 <br /> ripep <br /> c�nr[[,. S_r��Jo r li.n o_rrsn mbcr.ifany Is1L91 Filled voith�cement grout <br /> Township,Ranq<,and S-u- I <br /> i s[anee rom rices,roads.railwses,etc. —� <br /> i <br /> (3) TYPE OF WORK (cher!_), �rt4T <br /> New\Uc1l © Decpenong Reconditioning E] Destroying <br /> 1f destruction,describe material and procedure in Ilea:11. <br /> (4) PROPOSER USE (chech): J(S) EQUIPMENT: <br /> LDomestic ❑ Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> -. Other ❑ <br /> s (6) CASING INSTALLED: �r <br /> STEEL: OTHER: If gravel packed <br /> SINGLE ❑ DOUBLE <br /> I <br /> Gage Diameter j <br /> or of From To <br /> ft. ft. Dnm. \ball Bori ft. ft. <br /> ' }vr ui.hoe��rll ring: Six of gravel --- -_— <br /> lleseribr <br /> �. (7) PERFORATIONS OR SCREEN: <br /> 7]'pC of pCf ldfl hun o of screen ! <br /> Perf. Rows I <br /> ---�_— <br /> from 10 per per Size <br /> fr. _ fr. row fi. M.';Ind <br /> (S) CONSTRUCTION: <br /> a's,a wrfvc<s,ninrr sql Provided? Yrc ❑ No i 1 To what drpch <br /> Irene errv[s waled againsr puilurion? Yrs ❑ No ❑ if <br /> gr:,n c Jry[h f ost:_a[a <br /> - f4um, <br /> Fru fr-to fc. ]{ <br /> �^ Wnrk sea reed y NQ V Iy 72 ,completed Nov V 19 � <br /> _ _ 12 <br /> lkthod of saline WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled udder my jurisdicliwr and this rrporl is true to the,best <br /> of ruy knowledge arrd belief. <br /> UrPth aE which a'our was first lnund, i( known (t, qq C Co,it Jinq-level brfor, lserforlEinq, i(:kno fE. NA\4F. Clark bell r}, Equipment ment <br /> L ]n ding level a(mr prrforetinq and dcvclopin4 - fc. {Person,firm, r corpora cion} (Tpprd or prinrrd) <br /> (10) WELL TESTS: Address 2024 Fast Charter Way <br /> pump[rsEn d<? Yn ❑ No ❑ If Yrs.by'h."'? StecktOn CA 95206 <br /> ]' til./min.with f[.drawdown afcar 1" [SIGNED co <br /> �_1 <br /> Lrem prra[ure of..,ter �ti'a a chemical a Lysis mad,? Yrs Q No Q (trill Drill-) ll <br /> %V"sire Eric lug ,dr-f well? yrs ❑ s No I❑ If yr+.atrsch r<,py License No, 76602 Dated14 o V em b ux— 1 9,72 <br /> SKETCH-{ LOCATION OF WELL ON REVERSE SIDE <br /> LSWR 198 iFrv, 9.66i 15ir3-esu 9.6650H Twin,gyp ose <br /> L w <br />