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' ORIGINAL.— -- - - - - -STATE OF CALIFORNIA - - - - - - - - --- - <br /> - - - - --Do not ill 11= <br /> THERESOURCES AGENCY p� <br /> File with DWS DEPARTMENT OF WATER RESOURCES No. 153800 <br /> ,f latent No 85-312 h WATER WELL DRILLERS REPORT state Well No <br /> Leal Pcrturt No or pate 8 5^31 2 , <br /> Other W.1I No 1 <br />' ( d Total da <br /> OWNER Nim (12) WELL LOG 0 5 17 0 <br /> pd it Depth of completed well Et <br /> Address from ft to ft. Formation (Descnbe by color character size or material) <br /> City Zip - <br />' (2) LOCATION OF WELL (See instructions) 7 -22 Sand & Gravel <br /> Count- Owners Well Number 22 -45 C1a <br /> Well address if different from above <br /> Township Rangel Sectio = <br /> fro <br /> mc fm cities roads railmads, fences etc <br /> Ferr Rd . & Koster Rd . <br /> (3) TYPE OF WORK - <br /> New Well XJ Deepening ❑ <br />' Recanstrucnon 0 <br /> Reconditioning 0 188 -191 Clay <br /> Honrontal Well ❑ _ <br /> 193 Fin� Sand <br /> Destruction ❑ (Describe -2 1 <br /> destruction materials and 193 L <br /> ay <br /> procedures in Item 12) 252 -2 6 0 B l u e C 1 a <br /> (4) PROPOSED USE 260-265 Shale & Clay <br /> Domestic PUBLIC )b 265 -305 B l u e C l a <br />' Irrigation ❑ _ <br /> Industnal 0 <br /> Test `dell ❑ _ <br /> Stock ❑ _ <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ - <br /> i <br /> EQUIPMENT (6) GIIAVCI, PACK Sand & <br /> Rotary RJ Reverse ❑ Yes N No ❑ Size <br /> Cable [] Arrtt _ <br /> ❑ Diameter of bore <br /> Other ❑ Bucket ❑ Packed from. to17 C) �ft _ <br /> (7) CASING INSTALLED (8) PERFORATIONS <br /> Steel © Plastic Concrete ❑ Type of perforation or size of screen - <br /> From To Dia Cage or From To Slot - <br />' <br /> it it in Wall ft it size <br /> 0 170 8 160 120 140 Screen <br /> 150 170 Scrpen -- <br />' (9) WELL SEAL, <br /> Was surf-ice sanitary seal provided? Yes No [] If yes to depth 85 - <br /> Were strata sealed against polltstroril Yes 0 No ❑ Interval „ , ___ft <br /> Method of sealing- Work started 19.s s Completed_ _ 19 <br /> (1Q) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known -., �ft This well was drilled un r my turt,dtctron and this report is tnte to the est of m� <br /> Stand= level after well completion `� ft knowledge and belief <br />' (1 l) WELL TESTS SIGNED <br /> Was well test made2 Yes ❑ No T If yes by whom? (Well Driller) <br /> Type of test Pump ❑ Bailer © , Air hft ❑ NAME <br />' Depth to water at start of test ft At end of teat ft (Person, firm or corporation) (Typed or printed) <br /> ge _-al/min after „ours Water temperature Address 3525 P E N Dt A A <br /> ical analysis made? Yes ❑ No XD If yes, by whom? City- H a D E 5 T O_s C A __- Zrp 95356 <br /> oel <br /> ectnc log madel) les ❑ Noif res attach copy to this report License No Z9�1s-1nate of this repo <br />' DWR 188 (ftEV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />