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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT State Well No. 257162 57162 <br /> ce of Intent No <br /> v,c�l Permit No or Date Other Well No 4 J,(-2� <br /> (1) OWNER 4 Na _ (12) WELL LOG Total depth 54 ft Completed depth 5d_ ft <br /> Address 1166�z p1n Ave. <br /> from ft, to #t, Formation (Describe by color character sig or materia!) <br /> City ZIP <br /> (2) LOCATION OF WELL (See instructions) GSPP )tt-Acted bor-Ing Ing <br /> County.� ^'r- Owner s Wel!Numbe ALI <br /> Well address if different from above <br /> Township 3N Range 6E Section 35 — <br /> Distance from cities, roads, railroads, fences,etc — t4\ <br /> (g) TYPE OF WORK. — <br /> New Well jo Deepening ❑ — <br /> Reconstruction ❑ n <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> See 1?ricl<Dsed map Destruction ❑ (Describe <br /> destruction matenals and pro- n�� �✓� <br /> cedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial (� <br /> Test Well ❑ e\ <br /> ♦/, ♦ ♦ T f~ <br /> Muntct 1 �� ❑ � �♦\ ��i <br /> O er MO Or q-nc r �� �✓ <br /> WELL LOCATION SKETCH < ) I�l1 — ��♦�' <br /> (5) EQUIPMENT GRAVk,ACK <br /> 1 <br /> Rotary © Reverse ❑ ] No'O -L 412> <br /> Cable ❑ Air ❑ ete f bore l <br /> Other CSI Bucket—.0 L ramX el <br /> i �•2 ttr 54 ft ^�� — <br /> (7; CASING INSTALLED ► : (8) PERIrCA,I TIOn _ <br /> Steel ❑ PlasticTy or size <br /> From T i Cage or — <br /> •,� t <br /> ft fa\ i Wall size — <br /> +2.1 54 1 SCh40 33.7 '4\ _. .020 — <br /> (9) WELL SEAL _ <br /> Was surface sanitary seal provided? Yes 1X No ❑ Ifves tociepth__31..0 �fL <br /> Were Strata semled agaurst pollution? Yes$) NO ❑ Interval �nEL — <br /> Method of sealing - *nkll tarred 19 Completed 21:7 I9 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known 48.0 Ft <br /> Standing level after well completion 48.0 7hxs eel! rZ !led under m ]uru;rt—tion nd is report is !tree to !!ee <br /> ft best of m no edge and belie <br /> (11) WELL TESTS <br /> Signed <br /> Wu well test oracle} Yes © No ❑ if yes,by whom? I Driller) <br /> test Pump ❑ Bader ❑ Air lift Cl NAME <br /> 1 I to water at start of test ft it end of test ft. (Person firm,or corporation)(Typed or printed) <br /> Marge Pit moa after hours Nater temperature Address <br /> Chemical analysis made? Ya lel No ❑ if vim by whom? City ZIP 45201r--_ <br /> Was electric log made Yes ❑ No [X If yes,attachmpy to this report license No 57 7A R _ Date of this report <br /> DWR Iag (REV iyae) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM sy yy�ys <br />