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r ES ' 1 s�S9 <br /> Lie aMai WATER WELL DRILLERS REPORT Do Not Fill Im <br /> File with DWR. (sec:Loris 10" 7080,7021,7092,Water code) <br /> THE RESOURCES AGENCY OF CALIFORNIA N� 44214 <br /> DEPARTMENT OF WATER RESOURCE _�/ � Scace Wel! Na <br />,a 0 / Other Well N [✓ V / i <br /> (1) OWNER (11) WELL LOG. <br /> Name Total death it Depth at completed well fr <br /> Address t Farm.non Describe by color character size of material and structure <br /> it to it <br /> (2) L CATION OF WELL. <br /> County Owner i number tf any JV <br /> Township Ran and on <br /> Distance from cities roads n.iroadt era <br /> (3) TYPE OF WORK (check) .-aTitt <br /> New Well ❑ Deepening © Reconditioning ❑ Destroying ❑ <br /> If destruction describe material and procedure in Item 11 <br /> (4) PROPOSED USE (check)• (5) EQUIPMENT <br /> Domestic Industrial ❑ Municipal ❑ Rotary ❑ <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 /> it it Dram Wall Bore fr. fr <br /> Size of shoe or well nag � S....f Rr:vel <br /> Describe loin[ <br /> (7) PERFORATIONS OR SCREEN <br /> Type of perfora start or name of screen <br /> Perf Rows y "u <br /> From To per per Size <br /> it fr row it to xsn <br /> ,� , AL Y <br /> (8) CONSTRUCTION ' ` " <br /> Wit a surface sanitary seal provided? Yea (:1 Vo [] To what depth fr <br /> Were inv strata sealed agamsr pollvt.on s Yes ❑ No ❑ if vas note depth of treat. <br /> From ft to ft J yy ? <br /> Fra. it to it Work started /des( l942 Completed -,3,, S9 <br /> Method of sealttte WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS. This well was drilled under my lurssdictron and this report is true to the best <br /> of my knowledge and belret <br /> Depth at which voter v.. first fatmd sf know it <br /> ScandtnS le+ef 6efare perforans; If known fc NAME VA 'SLE-'i <br /> af[ec perfantmr and de+elopm; <br /> (Fersoo fire. or eorporitaon) (T/prd a ps,mWed) <br /> Standen; Ievel Et <br /> 10) WELL TESTS Address ig Q <br /> -tap Lest made° Y., ❑ \o ❑ ff vas by vhasnl /} <br /> cal min with it drawdown after his [S[CNEO] t7 "-�-Z- <br /> penturr of wiser Was a ck—$-1 analysis made? Yes 0 'Yo [,] ' (Wil!Drill <br /> Was eieemc lo;mad,of valla Yes '1 Vow if res attach copy License No�. <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 799 IRBY tt est sort-oso to sa sass IP <br /> a <br />