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I i�r STATE OF CALIFORNIA Do Not Fill in , <br /> ORlGfitiAL ^'!+' ^r 'THE RESOURCES AC <br /> ENCY <br /> i pp I <br /> Fife with DWR l DEPARTMENT OF WATER RESOURCES "N") 14 2 O O O j <br /> WATER WELL DRILLERS REPORT St7re Well No.—7j;_1 <br /> Ocher Well No.L4 <br /> (1) OWNER: <br /> 0 1) WELL LOG: i <br /> �.� i <br /> r: Name � <br /> Tddress -� � � Toca3 dryaii ft. Depth of compietrd veli 135 ft. <br /> F--6-7; Dnrribe dy rofor,rbenrw.rime o/royal mel,end rfr�rlorr <br /> (2) LOCA OF WELL: ft.rn ft. <br /> lanry� Owns's nssm her,if my � � <br /> Township.Range.and Section <br /> p Dis c fram r sicc d:. nil:oo d=� `... an�� •_ ! i <br /> (3) TYPE O—WORK (check): <br /> New Wel[ [ Dttl enin 4 <br /> P S � Rccondicion+ng (� Destroying [� _ <br /> f f destruction,describe rsralrria!arzd hrocedxrr in Hew I I. and =— --� <br /> (4) PROPOSED USEcheck : +� > <br /> ( ) (5) EQUIPMENT: <br /> Domestic [�J,Industrial ❑ Municipal ❑ Rotary <br /> Irrigation Im a 1 <br /> g ❑ Test Well ❑ Other [] Cable ❑ <br /> — - Other ❑ - i <br /> (6) CASING INSTALLED: - <br /> - - 1 <br /> STEEL: OTHER: If gravel packed -� - <br /> SINGLE D DOUBLE <br /> Cage Diameter - <br /> From I'u or of From To <br /> Wall Bore {_. fc ne <br /> mQ , „ q <br /> S'cc of aravrl: <br /> �r;cribr i�inc 1 <br /> (7) PERFORATIONS OR SCREEN: <br /> -; Type of prrio...iun ur tame of screen <br /> Pcrf. Rows <br /> -_� <br /> tom To per per Size _ <br /> it. ft, row f t. . <br /> -� ut.x in. <br /> (b) CONSTRUCTION- <br /> W­a su rfaee,anitary sal praridrd? Yes ❑ Nn ❑ To what depth g ft. --�--- <br /> IXrere env st nu scaled against pollution? Yes ❑ \o If yes,not,depth of s[raca i <br /> From ft. to fr. + <br /> i <br /> 1-rnn' ft.to ft. r /� –/� <br /> Warksuned '�3..b ig 76 ,Cnmpleud 4-2� ]9 !Cl <br /> Ncthod of sealing r WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well'-wax drilled tender my jurisdiction and this rrporl is Trus to fbe best <br /> DcptS at sfhich water w s first found. if kno of my bnoroledge and belief, <br /> a ft. <br /> Seant;n,q irvrl before p<rfan[ing, if knn n NAVE �.� <br /> 1 jnnding level after perfarariny and developing '(Pers r orpori4id'n) [Typed ar pNnrrd) <br /> E: f t. n <br /> (10) WELL TESTS: _ <br /> .Address 59-39-E, <br /> �xn � __, <br /> Wat pump test made? Yes ( No ❑ If yes,by whom? ✓]s�..Z 1 ` - –cT3���-C'ep-r&f�" <br /> .'d° <br /> 1' h <br /> gal.lmin. .drawdown after virh I" <br /> . 2 i <br /> hes. [$1GNED] - <br /> ,+rmpera cure of water VLrat a chemical anal ysir made? Yes Q No I] <br /> Gear stet tris log made of.+ell? Yes [] Itio If yrs,attach ropy 200794 � <br /> License No. Dared -� <br /> 1976 <br /> SKETCH LOCATION! OF WELL, ON REVERSE SIDE <br /> 1 — <br /> OWR 188 tREV. s-68, <br /> " t-]3]ON TRIP(T4 OSP <br />