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STATE OF CALIFORNIA DO not fill 111 <br /> Y <br /> . THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES NO. 118386 <br /> " WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No. <br /> (12) WELL LOG: Total depth__rift. Depth of completed well ft. <br /> :Address from ft, to ft. Formation (Describe by color, character, size or material) <br /> City Zip 24,2 - /A-- no?'f <L" <br /> /«y <br /> (2) LOCATION OF WELL ,(See instructions): u ��� �y <br /> vey <br /> County Owner's Well Number <br /> Well address if different from above <br /> Township Range Section 7 <br /> Distance from cities, mads, railroads, fences,etc. <br /> Ll/E <br /> - 7�i9 <br /> D — f —7.PiflE" O� fINO <br /> (3) TYPE OF WORK: /F <br /> New Well ❑ Deepening El a�T F Vy <br /> Reconstruction ❑ - A!9 <br /> Reconditioning ❑ - /�✓ e [L 'e�E�- <br /> I <br /> florizontnl Well ❑ - Y <br /> i Destruction ❑ (Describe --411 <br /> !vimy <br /> destruction materials <br /> procedures in Item - UN 7 <br /> }� <br /> (4) PROPOSED — <br /> Domestic <br /> f7 [W//,)L- ;jwo <br /> • Irrigalion</ <br /> IndustrialO ❑ C <br /> 11\\\\J <br /> El <br /> hf�miciplt — /J �/TTL �l1iE C <br /> WELL LOCATION SKETCH Other ❑ - C-661 y/ <br /> 5) EQUIPMENT: (8) GRA PACK: - ��Fr SN'� Y <br /> Rotary E] Reverse E3 Nu Size - Q /� E �/E <br /> Cable ❑ Air Elter of bore 719 <br /> - Of7 1/�` N <br /> Other ❑ Bucket <br /> C1 /E <br /> (7) CASING INSTALLED• (8) ERFOflA �S\• - /C <br /> 754 <br /> Steel ❑ Plastic E] G c t Type of pe r n orze of scree - FT NDy <br /> Froin To Dia. G< e r F To 1 <br /> ft. F in. Wall ft. si - <br /> _ <br /> 7 <br /> (9) WELL SEAL: 57/ <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If yes, to depth ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval-_ft. - <br /> Klethod of sealing Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft This well was drifted under my jurisdiction and this report is true to the best of MY <br /> Standing level after well completion ft. knowledge and belief. <br /> (11) WELL TESTS: SIGNED <br /> \Vas well test made? Yes ❑ No ❑ If yes, by whom? (Welll <br /> Driller) <br /> rype of test Pump ❑ Railer ❑ Air lift ❑ NAME ' <br /> Depth to water at start of test ft. At end of test ft (Person, firm, or corporation) (Typed or printed) <br /> Discharge-gal/min after hours Water temperature Address <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? '- <br /> City Zip <br /> Was electric log made? Yes ❑ No ❑ If yes, attach copy to this report License No. Date of this report <br /> DWR 188 (REV. 7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> - t r <br />