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ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> ,Ffle with DWR (Sections)079,7080,yogi,7082,Water Coda <br /> THE RESOURCES AGENCY OF CALIFORNIA N? 23584 <br /> DEPARTMENT OF WATER RESOURCES State Well Na ��7 <br /> Other Well No0ZS05,5Z2 SG <br /> + L (1) OWNER: (I l WELL LOG: <br /> LNameS17 ( Total depth /. '7 ft. Depth of completed well ft. <br /> Address Q(.� C1.-�'� Formation: Dnnibr by color,cbereder,size of mcterisl,and structure <br /> QLD' r <br /> ([,to ft, <br /> (2) LO ON OF WE : / <br /> Cate-[ &� ner'e-umber,if any = r <br /> Township,Range,an non <br /> LDiss-c rom cities,rands,nils-ade,etc. — U <br /> (3) TYPE F WORK (check): <br /> New Well 0 Deepening [] Reconditioning 0 Destroying [] <br /> I/destruction,describe material and procedure in Item 1I. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic O Industrial ❑ Municipal ❑ Rotary <br /> F Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> 1 L (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLEX DOUBLE F1 <br /> Gage Diameter <br /> From To or of From To <br /> ft. it. Diam. Wall Bore ft. ft. <br /> E <br /> Size of shoe or wril ring- Size of gravel: <br />� <br /> Describe join[ See. 1'37r <br /> f (7) PERFORATIONS OR SCREEN: <br /> Type of perforation or name of wren <br /> Pert. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Was a surface sa-nary sea]provided? Yes5c No❑ To what depth �1 0 0 ft. <br /> Were any scrap sealed against poll-tion? Yoko No❑ If yes,note depth of strata <br /> From io ft.to QQ ft. <br /> From ft.to ft. Work started 19(p ,Completed l9 <br /> Method of reAli-g WELL DRILLER'S STATEMENT: <br /> {9} WATER LEVELS: Tbis well was drilled under my jurirdirtion and this report is true to the best <br /> of my knowledge and belief. <br /> Depth at wbich water was first found,if k-own it. f r <br /> Standing level before perforating, if.know- f[. NAME <br /> (Person,firm,or corporation) (Typed or printed) <br /> Sanding level after rfees ti-p and develo is - f[. <br /> Address--7/42/ p <br /> 'I0) WELL TESTS: ` 1, C -5 <br /> onmp telt made? Yes No If yes,by whom? <br /> Ft <br />�i gaLlmin.with it.drawdown after hue... SIGNED] Q. s <br /> (Well Drille <br /> Temperature of Waa a ehemlcll iaalysis made? Yes ❑ No <br /> Was electric log made of well? Yea ❑ No If yes,attach copy I License No./ ?r!f-Tate I <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV.9.67) unset-oro to-ea 50M TRIP osr <br />