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# If <br /> — -0BIGINAL — — - - - — - - WATER--WELL--DRILLERS -REPORT— -- — -Do Not Fill In =- <br /> Filo with DWR (Sections 1079,7010,7091,708,Water Code) N? 26237 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> State Well No _ <br /> DEPARTMENT OF WATER RESOURCES WAOther Well <br /> i <br /> (1) OWNER. (11) WELL LOG: <br /> Name 1,jAy-1 IS rI?�J ��; Total depth 9Q it Depth of completed well it <br /> Address r' � r. <br /> L. J Formstenns Derrztbe by+afar,tlfer.citr,site of Muer&!,and structure' TRjjry, C1 P it to ft <br /> (2) LOCATION OF WELL <br /> Cova[y Owner s number if ape Clay <br />' <br /> Township Range apd Section rT1 h S 1 r/ sana <br /> Dutancefrom cities roads railroad, etc I N ( F r Ot'T { 15 46 cja,�: 2 shal A <br /> (3) TYPE OF WORK (check): <br />' New Well gJ Deepening [] Reconditioning © Destroying ❑ 68 74 srrd, f-Lne <br /> if destruction,describe material and procedure in Item 11 <br /> 74 77 o lay- <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: <br /> Domestic ® Industrial ❑ Mumclpal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable [❑ Q <br /> Other ❑ <br /> (6) CASING INSTALLED, <br /> STEEL OTHER If gravel packed <br /> SINGLE ff DOUBLE M <br />' Gage Diameter <br /> From To or of From To <br /> ft ft D1am Wall Bore ft. ft <br /> 1 1! <br /> N <br /> Size of,hoe or well ring Si.e of(rrsvel CONFIDENTIAL Z ry �] <br /> Descnbe p"O'f'o,ratiGn <br /> Water Code Sec. Z3t 52(7) PERFORATIONS OR SCREEN: <br /> Typeof or name of screen <br /> Perf Rows <br /> From To per per Size <br /> ft ft row ft in x sn <br /> 6 1, <br /> 1 <br /> (s) CONSTRUCTION. ,,�yr <br /> Was a surface sanitary seal prawded? Yes CK No ❑ To what depth 0 it <br /> Were any Strata sealed aga nn pollution? Yea ❑ No❑ If yea note depth of strata <br /> From it to it <br /> From it to ft Work started 19 ,Completed 'T i 9 19 V <br /> Method of,ealin CLt-iV WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS. This well war 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 it y, <br /> Standing level before perforating1E <br /> if known ft NAME NNINGS BROS . <br /> (Person firm or corporation) (Typrd or printed) <br /> Stoadin level after perfan[ia and developingft <br /> (10) WELL TESTS: Address RT. 2 500 W. RUMBL73 RD . <br /> pumptest made, Yea ❑ Na ❑ If yea by whom? MO ESTG CA F . <br /> t d ltal 1m,n with f, drawdown after hrs SIGNED] <br /> Temperature of water Wa,a chtmicsk analyna made? Ye, ❑ Na ❑ ((Tell Drilled <br /> 'Was cite Enc io C)made of well? Yes ❑ No 1f yet attach copy License No— Dated -- <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> ' DWR I 8 (RFV 9 6!? 00391 P60 10 46 50M TniP OO A Dap <br />