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Los STATE OF CALIFORNIA Do Not Fill 1w <br /> THE RESOURCES AGENCY A7 <br /> ORFilewith UWF - DEPARTMENT OF WATER RESOURCES NO 142011 <br /> WATER WELL DRILLERS REPORT State well No. <br /> .. Other Well No <br /> ( 1 ) OWNER : ( 11 ) WELL LOG : <br /> Name FT -. n1 , `_ j_ _ _ - Tosil eeom r! ft. Depth or completed .well in. it. <br /> ' Address4 ' , 3r- wrii P. ? Vis_' Formation : Describe by Eclat, character, size <br /> of ne«riat, and s lrartarr - <br /> - otlr CH — ft. n. <br /> (2 ) LOCATION OF WELL :. <br /> Countv owner's number. if any <br /> Township. Ran and Sec d " l � <br /> Distance from cities, roads,railroads. etc. and1 <br /> ( 3 ) TYPE OF WORK (check) : _ - <br /> 74 <br /> _ , New Well Z Deepening ❑ Reconditioning ❑ Destroying 0 if destruction, dnsrribr inarerial and proredtire. in liens 11 . - <br /> 95 <br /> 'i ( 4 ) PROPOSED USE (check) : ( 5 ) EQUIPMENT : R 1 - 27 <br /> Domestic ❑X Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> j ( 6 ) CASING INSTALLED : _ <br /> ! <br /> STEELOTI If gravel packed <br /> -" S - <br /> SINGLE 1] DOUBLE ta ! <br /> Gage Diameter 11 � - <br /> from ' I'o of From To <br /> - - ft. Is. .D;am. wall Bore - <br /> 13 C <br /> mie - ,Ime wall r Site of staid <br /> es : <br /> be5L <br /> 'be — IG <br /> _ ( 7) PERFORATIONS OR SCREEN : <br /> _TSpe of Pcriurin o UC name Of SC nln .' i <br /> Pert. Rows <br /> From To per per Size <br /> is . ft. row ft. <br /> ,� ( d ) CONSTRUCTION : <br /> All. a aurLce sininry mal provided ? Yes ER NO ❑ To what drink ft. <br /> - olere Ain sena scalrd against pallor Yes ❑ No — if yea a depth of strata <br /> - _ b From ft. a <br /> it. Works ted - , Completed 5 19 't6 <br /> Method of veiling WELLDRILL 'S STATEMENT: <br /> This well was drilled ander any jurisdiction and this report is trite to fbe best <br /> ( 9 ) WATER LEVELS : of my k aorplydge and belief. <br /> Depth at which water was first found, if known fr. �. <br /> andiras level bNur u(or inp, if kno fc NAME Ln VRf"`" J <br /> (laers n, firm, or corporation) ( Typrd or psi erd) <br /> - anding level after perforating and develop <br /> ^� � <br /> ( 10 ) WELL TESTS: Address <br /> Was pump test made? Yes `i: No D If ves, by whom ? Iorl 2 " <br /> ' 75 fral. imin. witb ft.. drawdown after hiss. (SIGNED) <br /> empera <br /> e <br /> of a s <br /> Was a chem cal analysis made? Yes. 0 No El ( Well D.illrr) <br /> " Electric lag male of well? Yea ❑ No F] If it x6 COPY License No. Dared Is <br /> ! 1 - SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> Li <br /> O W R 1 Be ( REV . 9- 681 1 sop TRIP C)r osis <br />