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'i <br /> i ----------------- <br /> I <br /> STATE OF CAUFORNIA <br /> 1 DUPLICATE THE RESOURCES AGENCY Do riot fill in <br /> OE-.aRTMENT OF WATER RESOURCES <br /> Drillerrs Copy <br /> WATER WELL DRILLERS REPORT No. 313810 <br /> k Nolicr of inirnt No Stats Wrll Nn <br /> Loral Permit No.or Date Other Well No <br /> i <br /> j (1) OWNER: Name G�/+d_��.Cn (12) WELL LOC: Twat depth 2�J -it (�,mplcted depth $-ft. <br /> Address -37 ,i sk'ge from ft, to ft. Formation(Describe by color,character,size or material) <br /> City V2. :S a i. ror,r,r..>FO _ _ --ziP 9r,691 <br /> (2) LfDCAT1ON OF WELL(See instructions): <br /> 4 <br /> C,ounly Owners Well Number — !_J►? err!_-_�0�� _ _ <br /> I _ <br /> Well address if dilferent from above — r• <br /> Township Range Section <br /> Distarim from cities,roads,railroads,fences,etc. <br /> _ � � rpls•aadctd •P'^u_ <br />' — � rte iJ� •J <br /> i <br /> (3) TYPE OF WORK: — t' ruxod iR r �' r ✓ <br /> I New Well ❑ Deepening ❑ <br /> .. !� r 4 <br /> ReCORReconstruction0 , OWO � <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> ' Destruction ❑ (Describe ,L1 <br /> destruction materials and pro- �7 <br /> N :eclures in Item 12) is4r! p S fq r <br /> (4) PROPOSED Ql <br /> Domestic _ C{ r a S J <br /> .0, rr <br /> Irrigation d. <br /> Z Industrial ❑ _ pr _Lm�r- y <br /> Test Wel) ❑ <br /> Munici ❑ <br /> qbk <br /> 1 <br /> er <br /> j6dWELL LOCATION SKETCH �) 1 y7 — <br /> (5) EQVIPR��7/ENT: RAV G7( <br /> Rotary K Reverse, ❑ No i - --- <br /> Catele ❑ Air ❑ tel !sore — <br /> other � 8uck from <br /> /C'I a ,�� t _ <br /> (7)CASINO INSTA LF. . <br /> (f!) PE TI O <br /> Steel ElP e Ty of 'unardw _ <br /> 1)' Ca a or of <br /> From g <br /> ! ft. f Wall size — <br /> L <br /> (9) WELL SEA : <br />� J <br /> Was surface sanitary seat provided? 'Yes No ❑ tf yea to depth <br /> I We_reslntasealed agaimt llution? Y No ❑ Interval ft. <br /> Method af"hiri ttrf!,�'fi Work started 19 Compfel 1 <br /> I (10) WATER LEVELS: I � � ;HELL DRILLER'S STATEMENT: <br /> l Depth of first water,if known + rl <br /> Thi., well tuns drilled urider ns jurisdiction and this reporr is true to the <br /> Standing level after well minpletion_ P hest of my knowledg°and belle sl <br /> (11) WELL TESTS: - --- <br /> Signed <br /> Was well test made? Yes ❑ No 0 11 yea v sum? <br /> Typr of Int Pump Q„ Railer Air lift ❑ N 1Mk. t ,tom LC1 a. <br /> I]cpth E.wale:al dare of test 1 4;`fit At end of test— II n, L m rnr snl(Ty I nr printed) <br /> I Discharge__-- gal/minafte, fa n Water tempe-IiiP_ Atldsess <br /> Chemical analysis madO Yes 0 No ❑ Pyrs,bywhom)__ laky I <br /> We,selrnnrlogmadr Ym ❑ No ❑ II yrs,aita6mpylothssretwrl Llcrn.e No 4j �, ^ 1)dfr•of IML relxxl <br /> IF ADDITIONAL. SPACE IS NEEDED, USE NEXT CONSERD <br /> CUTWELV NUMBEEFORM <br /> oWW Lda INEv, IS-Eat 06� <br />