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STATE OF CALI FORNIA Do Not Fill Ba <br /> THE RESOURCES AGENCY A7 <br /> -:, FiliFilewithUWF - DEPARTMENT OF WATER RESOURCES N2 142011 <br /> WATER WELL DRILLERS REPORT star` 'e° No. <br /> ' Other Well No.l <br /> ( 1) OWNER: (11 ) WELL LOG: <br /> Name F TCfll: f=i ' Tosil drnm I rl P. ft. Dcmh of comPlezed well jam. (v. <br /> Address If i I'. 3 r-inn i_Fl ?V L For Drvr.lbr bT mlor, eh...ere.,n, ij or.vrief,cnd rlrurtvrr - <br /> - ot'r LH - <br /> (2) LOCATION OF WELL:. <br /> Cnonvv. - Ow mber if anv <br /> Township. Range,and S,,ion <br /> Dinntie from citiev, roadr, railroads. eoc. 1 <br /> (3) TYPE OF WORK (check): - - 14 <br /> New Well Zj Deepening ❑ Reconditioning ❑ Destroying 0 - <br /> 1l destni rtlon, drsrrlbi nwtnial anA proredure in lie].. 11. - <br /> (4) PROPOSED USE (check) : (5) EQUIPMENT: R I - <br /> UU <br /> Domestic ❑X Industrial ❑ Municipal El Rotary <br /> ` <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> j (6) CASING INSTALLED: <br /> STEEL OP If gravel packed <br /> —" S <br /> SINGLE L] DOUBLE kr) r P J(v._ 6JIJ <br /> Gage Diameter 1j,} <br /> 'fo or of Frost To <br /> ft. ft. .Dian. \fall Bore ft. ft. <br /> 371 1 C <br /> mz<ui,Ime�r ..ell r sire of a tel: <br /> _ (7) PERFORATIONS OR SCREEN: <br /> r>pe of nrd�rad�nP nfr nlnn _ <br /> Pert. Rows <br /> From To per per Size <br /> -' fi. ft. tom ft. in. xin. <br /> CONSTRUCTION: <br /> a,urface,min ry real provided? Yes ER No ❑ Tp w6u dt,,k ft. <br /> - W'e cal.d againu poll union? Yo ❑ No — If it a depsh oLu <br /> rm fs. (s. works and - 19 b Cmnpleted 5-9 Is 76 <br /> rr� <br /> btechud pt,coon, WELL a DRILL 'S STATEMENT: <br /> This wrll uns drilled trader my jurisdiction and this report is live to the best <br /> (9) WATER LEVELS: of my knwetrdge and belief. <br /> Depth as whVeb w w s fiat found, if km fs. <br /> V <br /> :. <br /> sundin; level bNura pu(Or ing, if knn fs. NAME <br /> (Pen n, firm, orppnslonj (TrPrd or Pri.,,d) <br /> -i Suadi, level afn, perfur ine and develop.np <br /> (10) WELL TESTS: AddAddict,W4 pump list made? Yes EL,i: No ❑ If yes, by whom? r <br /> ' 75 nl r ish ft.. drawdow arse he, (SIGNED) <br /> r em a of w e m kt'as a them cal analyri made? Yes.0 Na ❑ (Well D.YIn) <br /> pr f <br /> Wa d.c cc Is,m.d.of well? Yes ❑ Ni, ❑ If ry ....6 copy License No. Dated . Is <br /> ! - SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> Lj <br /> nWR ]Be IFEV. 9-6R1 4]230M TRIP Qr O3P <br />