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QUADRUPLICATE °� STATE OF CAU FOR NIA —.
<br /> Use of Comply With THE RESOURCES AGENCY Do not fill it,
<br /> local requirements
<br /> \mice o(]moot Nu. DEPARTMENT Off' WATER' RESOURCES
<br /> — - WATER WELL DRILLERS REPORT No. 190842
<br /> E.nc:d Yc rnoit No. or r)aier} State Well
<br /> Other Well ;a\'u- ,._.`_ -- .
<br /> ( 1) OWNER: Nam,_ �} V P�1 �3 f7
<br /> —.. (12) WELL LOG: Total ae,ul_.��"�••--��
<br /> t �-�Lft. Uepth of rmnplc•Icd ,cdl��it. �
<br /> from ft. to Et, l nr�nat"o (I)cs,ril>r by color,
<br /> l;il>- .-�'Lilp�. —_� acha r:;ctc:. size nr male ria])
<br /> (2) LOCATION OF WDLL (see instructions); 16 -
<br /> C;sunty�
<br /> -an- jLof-q-wn- - O+vncCs Well Nn;nher__ __ -- 44 l
<br /> Well address if dn
<br /> different fr ,n alrnve �— _-_— 44 t/Vl L Clay
<br /> '1'n,v;,sltip� [Sanl;e Scetiw�_—.�.
<br /> 105 - 1{0Sand,
<br /> I)istxnce from cities, roads, miln,ads. fenc•e:s, etc--h-LU ne _
<br /> "5 - 135 Sand`'
<br /> 13
<br /> (3) TYPE OF WORK: -;
<br /> New Well td,�/ DeepQjIlk ❑ (�
<br /> Itevnnsbuctlnn ❑ - �`\
<br /> Reconditioning ❑ _ - �,
<br /> (
<br /> llori trll Well ❑ �•�\ _ :�
<br /> Dcstnrctiou ❑ (Describe
<br /> ':�� �
<br /> destnrctinn materials arfil (�-' .
<br /> Procedures inltem ),2
<br /> (4) PROPOSED \ `•
<br /> t
<br /> Irrigation ,� -
<br /> Industrial ❑ �.`� ♦`. _
<br /> Test,Well ❑ :� �� - }�A� II
<br /> /i
<br /> � I
<br /> WELL LOCATION SKETCH -Other
<br /> 5)
<br /> iS1 EQUIPMENT: �J •�Y
<br /> �G) GSAVEL'+,l'ACK:
<br /> �/ 7
<br /> Rotary' Ly, Reverse ,L , NoSize-
<br /> Cable
<br /> ❑ � L_)'s [] Size_ �
<br /> (:,dole Air ,urc L)iaitf
<br /> Other ❑ tiuckel Parkedfnmp�.tlL.,.- to=_ -7
<br /> (7) CASING INSTALLE•D:i't" •
<br /> Steel ❑ Plastic []x Concrete
<br /> -L1 Type of perf.1{atirm or size uF sercen•:� '•. - -
<br /> t
<br /> 1�,rom To,,, Dia_ Gaffe 01, I'rbna�;',, �) To
<br /> It. ft. : in. Wall ft:;', - ft. `size` _
<br /> 3 160 117 � � -
<br /> (9) WELL SEAL:
<br /> Was surface sanitary seal Provided? Yes EX No ❑ If Yes, to depth- 50 Ft"
<br /> Were strata sealed against IanllulinnP Yes ❑ No ❑ Interval— „" ft.
<br /> Methtsd of sealin(y B.f'T:L`on i t Work start JgjjE, nrPle ]g,
<br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT;.,,
<br /> of first
<br /> Deptli rst ater, if knowri .-- ft- This well was drilled under inV iurisdictionYn�fhis rc"!aY'Zs tB:l(I, 0\C be of m�
<br /> S. t _ft. knowledge and belie/, _ +^ '4' ^r
<br /> Standing level after well anv rletinn - 4�� .�,. ,r i , >
<br /> . .
<br /> (11) WELL TESTS: SICNIEd
<br /> Was well test made? Yes ❑ No LX If yes, by whom? - (WellDO(rrh •_F'
<br /> Type of test Pump ❑ Sailer ❑ Air lift ,
<br /> ih•p!h to +nater at start of test ft. At end of test Et (Person, lino, nr corpora} l) pert nr pr irlte )
<br /> i)iacharge gal/n,iu after hours Water temperature Address 252S_QELAN"Al `—
<br /> Chemical analysis lelade? Yes ❑ No LX 1f Yes, by Whops? City Y� 96�.�'-o
<br /> yeas elcctliC lot; made? Yes ❑ No ' 11 yes, attach copy to this report License No. t f'
<br /> 1 S �;i-3,L.0�� Date r,F this repor
<br /> DWR 18D (REV.7-76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM ..4 I
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