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A ORIGINAL STATE OF CALIFORNIA Do not fill in He with DWR THE RESOURCES AGENCY p� + DEPARTMENT OF WATER RESOURCES No. 065061 of Intent No. WATER WELL DRILLERS REPORT State Well No. ....1 Permit No. or Date Other Well Nod 'rl) OWNER: Name C e n t U r 21 Yeo a n s Rea 1 t (12) WELL LOG: Total depth_L.,it. Depth of completed wellr.J ft. `ddress P X 1212 from ft. to ft. Formation (Describe by color, character, size or material) in Tra ry_,� Zip -5376 0 - 7 Top Soil '72) LOCATION OF WELL (See instructions): 7 - 9 Clay/Sandy Sand +a n d County_5 a n �Q a )d 111 _Owner's Well Number. 9 - 64 C 1 a San d :ell address if different from above 8197 14. Hwy 50 Trac 64 - 66 Sand 4ownship------0 G `✓ Rang Q Sectio 66 - 105 C 1 a Distance from cities, roads, railroads, fences,etc - 119 - 170 1 ^. (3) TYPEOFWORK: — New Well [J Deepening ❑ - Reconstruction ❑ = Reconditioning C. Horizontal Well ❑ �.� - Destruction ❑ (Describe = destruction materials and procedures in Item 12) (4) PROPOSED USE: - Domestic d/ - TIrrigation - ❑ - - Industrial ❑ - - Test Well ❑ - 1,r1 Stock Q - - Municipal WELL LOCATION SKETCH Other ❑ I - `-- -5) EQUIPMENT: (6)YGRAVEL PACK: Sand 81. Rotary ] Reverse ❑ Yes Yy No ❑ Size Gravel _ :able ❑ Air ❑ Diameter of bore 1211 - - &Other ❑ Bucket -1Packed from 7 0 to_ 12 5__w. _ (i) CASING INSTALLED:_ (8) PERFORATIONS: - teel ❑ Plastic (X Concrete O Type of perforation or size of screen - La Froin To -1 Dia. Cag"r From,.. To .Slot ft. ft. in. Wall ft `• ft. sire' - 0 125 6. 160 105 125 - Screen 19) WELL SEAL: ti — Vas surface sanitary seal provided? Yes l No ❑ If yes, to depth 7`ft. - "Vere strata sealed against pollution? Yes ❑ No ❑ Interval ft. - Method of seating Work started Ma r 19_32 Completed 19 10) WATER LEVELS. WELL DRILLER'S STATEMENT: )epth of first water, if known H• This well was drilled under my jurisdiction and this report is true to the best of rap "Standing level after well completion ___ f 1 ft. knowledge and belief. (11) WELL TESTS: SIC Vas well test made? Yes ❑ No & if yes, by whom? (Well Driller) •ype of test Pump ❑ Bailer ❑ Air lift ❑ NAME H E N N I N G S BROS. DRILLING CO . INC . X6-1 -+th to water at start of test ft. At end of test fr_ (Person, firm, or corporation) (Typed or printed) arge _-"cal/min after—_--hours Water temperature Address 15195 PFI ANnAI F A1fF }} ty p95;366 — -�„lical analysis made? Yes ❑ No )0 If yes, by wham? Ci Vas electric log made? Yes ❑ No XI If yes, attach copy to this report License No, 290813 Date of tbis repo 7 DWR 188 (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM L