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ORIGINAL WATER WELL DRILLERS RE ELT <br /> Do Not Fill In <br /> _ File Original, Duplicate and Triplicate with the ls.eaiona 7076, 7077,7079,wars.Code) <br /> DIYISION OF WATER RESOURCES State u''cll No----------------------_ <br /> P, o. BOX lops STATE OF CALI FORN IA—DEPARTMENT OF PUBLIC WORKS <br /> 1 SACRAMENTO 5. CALIFORNIA DIVISION OF WATER RESOURCES , ' Other )WANo._._._-___ ---------------- <br /> Begins ___.. <br /> ..._—----------------__------------.----------------__. <br /> '1) DRILLER: (person, firm, or corporation) (8) LOCATION OF WELL: <br /> j Name sT(IclnoN tB--fuEE Re fd'1Tfh v u Coo — <br /> 0" S <br /> Address 646 SOUTH CALIFORNIP ST5F'ET x.F.D.or sneer No g3—d d .� s <br /> OWNER: <br /> Name "r 0 T) GpQr yp <br /> Address 35='6 Harvey (9) WELL LOG: <br /> Sto. -ton, California Toal depth ofwell 120 <br /> _ Formaaion: Menu..size of wa ec Sragel— <br /> (2) Proposed Use (Check) Equipment 0 to 3 ft. Top Soil <br /> Domestic Industrial ❑ Rotary ❑ <br /> 3 " 18 Yellow Clay <br /> ® 18 24 •• Yellow Sand <br /> Irrigation ❑ Test Well ❑ Cable 2 y <br /> a Dug Well ❑ 4 42 Yellow Clay <br /> Municipal ❑ Other ❑ Ocher ❑ 42 2 Blue Clay <br /> 52 ^ 67 Blue Sand <br /> (3) CASING: 67 •' 110 •• Blue Clay <br /> 70 fr of 6 .. 14 lb./ga. a r,ng let. I. well 110 .. 120 •' Gray Sand Gravel <br /> Type and size of shoe or well ring .. „ <br /> f4) PERFORATIONS: <br /> - ye of p<rforamr used <br /> 'peer ovsea - f,. to ft. holes per in. ,• , <br /> DFameie, of pecforaelons in., length <br /> I <br /> : 5) WATER LEVELS: <br /> was elecmc IS,made of wdD ❑ Yet J No If yes,attach copy. <br /> Depth a which water was firs. found 18 ft. <br /> 1 i Sanding Ieyel before performing f,. •' <br /> Sanding level she, perlorning ft. •' <br /> Note von,obss,vssmr,of any change in wmer Inel while drilling <br /> ¢'as a mdaec saniar,seal Provided? - <br /> (6) WELL PUMPING TEST: Work scrod 5_5 14 52 Completed 5-5 14 52 <br /> Cspaci,, Bal./min. is. draw down Due of Report June 2J, , 14 52 <br /> WELL DRILLER'S STATEMENT: <br /> -' a'as well grad packed? This ,ell ills Ilrilled :order Illy jarind lion and this report is tree to the belt <br /> any s rua sae Bamst po o in knou•Irol a and hrlir . <br /> r Ida Ilnion? I ) 3 p <br /> Amch <br /> .enperature was a ghemi6l analysis made? copy [SIGNED].,afLt '� ..f._ J— _. .. .. <br /> -- If abandoned w•as well capped? - N''eil Drills <br /> $Y--ST4Qi:'.TOt)_.6€ ./LT E; &. -''7u==--11-- ---------------- -- <br /> (7 TYPE OF WORK check - 67850 C_57 <br /> ) (check): License No....1..._....._...-_.....-..__...._....__Classifintion..._.. <br /> New well i$ Reconditioning of well ❑ <br /> Dated--------._-_-----------_------------------ ____.____-------------_---—__, 19-_._-..-_ <br /> Deepening existing well ❑ acavo am soa euln 0sec <br />