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~ STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES 1�7�T <br /> ? 89321 <br /> File with DWR <br /> WATER WELL DRILLERS REPORT Stare well No. _ <br /> Other Well No $ t_��� <br /> (1) OWNER: (I 1) WELL LOG: <br /> V <br /> Name Randy Sasspr Total depth <br /> 203 ft. DeP[h of completed well 63 fr. <br /> Address Farmaxion: Drsnibr by rotor,rhararrer,rix of metrrial,and s7n rl9rr <br /> ft. rn it- <br /> '""' (2) LOCATION OF WELL: Loe <br /> l,ouaty Owner's number.if anv ��. O_ m <br /> Township,Rmge,and Section 4-2 <br /> 7 clay <br /> `w9 Disunce from cities,roads,railroads.erc. 27-29 <br /> 9 <br /> 'rte IL-1 1117- 'S H 1 v 14Iq 'St 29—�l clay <br /> (3) TYPE OF WORK (check): 33-16 Sand <br /> New Well 5a Deepening ❑ Reconditioning ❑ Destroying ❑ —1+6 Qlay <br /> r.. <br /> If deslruelion,describe material and procedure in Item 11. 46-61 Sand <br /> & Gravel <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 61 -101 <br /> Domestic ® Industrial ❑ MunicipaI ❑ Rotary [E 10�-105 Sand <br /> +�+ Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> 105-1 �6 Clay - <br /> Other ❑ � _ <br /> (6) CASING INSTALLED: <br /> 41s. STEEL: X OTHER: If gravel packed _ --,'---and - Grnyel <br /> SINGLE [X DOUBLE ❑ <br /> Gage Diameter <br /> From 1'0 or of From To <br /> fi..a ft. ft. Diam. Wall Bore ft. ft. <br /> "a! <br /> Sne of shoe or well ring: Sian of travel: <br /> D.—ib,j—, <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perionliun or name of screen i' EN `f IAL <br /> Water Code Sec. 13752 <br /> Perf. Rows <br /> From To per per Size <br /> *+ fr. it. row ft. in.z in. <br /> t1 <br /> it <br /> (8) CONSTRUCTION: <br /> W„ surface sanitary seal provided? Yes f2 No ❑ To what depth 30 ft. <br /> Weft any strata sealed against pollution? Yes❑ No❑ If yes,note depth of strata <br /> From ft.to ft. <br /> V Fru. ft.to it. Work tarred 19 ,Completed 19 <br /> sinhod 9f walinrt WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This uell was drilled render my jurisdiction and ibis report is true to the best <br /> of my kootuledgc and helief. <br /> i..r Depth at which Rarer was firs[ found, if known ft. <br /> standing level before perforating. if known ft. NAMEO <br /> (tenon,firm,or corporation) (Typed or printrd) <br /> St—dine I—el after Perforating and developing FL. <br /> (10) WELL TESTS: Address <br /> .r <br /> •Vas pump test made? Yea ❑ No If 5150 <br /> yex,by wbom? <br /> l q/ <br /> t tld: gal.lmin.with ft.drawdown afte hes [SIGNED] <br /> r (Weil Driflrr) <br /> Temperature of water Was a chemical analysis made? Yes ❑ No .1 <br /> y Was electric lob made of well? Yes ❑ No fie If yes,attach copy License No. l �.t ,�7- --Date_ <br /> SKETCH LOCATION OF WELL pWR 108 (REV.9.68) '/(slr//ON REVERSE SIDE: <br /> 60 / /l/ 2St19-n30 4-66 Sped TRIP AD 050 <br />