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•`"� `� Do Not Fill I <br /> /YSTATE OF CALIFORNIA <br /> (= �I t In <br /> THE RESOURCES AGENCY N� 94652 <br /> ORIGINAL t DEPARTMENT OF WATER RESOURCES <br /> File with pWR <br /> WATER WELL DRILLERS REPORT SLatC\Vdl `<,. - - <br /> Other \Voll No.— <br /> (1) <br /> o.(1) OWNER: (l l} WELL LOG: <br /> Namc Total doth <br /> a u,.„p <br /> Address2 <br /> leled w;II Ir, <br /> r rffr< <br /> 7-5 <br /> y <br /> -1 <br /> (z) LOCATION OF WELL: ' <br /> Co,urty t)wncr',n mhcr.if., �� ' _ -r - <br /> 1'—'.'ip.R-"and S-6".' . <br /> I)r�rzncr farm otic,.rnxis,rails wis, <br /> f <br /> (3) TYPE OF WORK (,fleck): — <br /> NewWell P--�Dccpening ❑ Reconditioning ❑ Dcstraying ❑ <br /> If drslrurtion,describe eaalerial erred prorrdurr in Ilene [I. <br /> (4) PROPOSED USE (check). (S) EQUIPMENT: <br /> Domestic [ dustrial ❑ Municipal ❑ Rotary ❑ — <br /> Irrigation ❑ Test Well ❑ Other L] Cable 7 <br /> Other ❑ - ~' r ' <br /> t6). CASING INSTALLED: <br /> STEEL OTHER: 1f gravel packed <br /> SINGLE OOURL.E ❑ - <br /> (;Jgc Diamctcr <br /> I-rom i'u or of From fo <br /> ft. it. Diam. Wall Bore Ft. ft. <br /> Sao of ,hc, clt riop;� /C 5?.e„}, •el: <br /> i)e,e ri hr nt l <br /> (7) PERFORATIONS OR SCREEN: <br /> I'ype of : <br /> Perf. Rows <br /> hrom To per per Si'rc <br /> ft. it. row ft. m. zin. <br /> (8) CONSTRUCTION: <br /> A'-a-rface,.r n,,-se.vi p-idcd7 Y" ;_1 No I-1 "3-u alar deprly h. <br /> -I'd araonst yxrilu Gnr,? Yes [,i Nn [; If rr,.Wore deed,of strata <br /> -rnrn ft. ❑, ft <br /> Pr,m ft. fl. Wfnrk St xr h•d I'1� -Cop,pi[tr,1 r'1 <br /> airrh J of-1-g WLLL DRILLER'S STATL'MI--NT: <br /> (9) WATER LEVELS: This veli tuns drillrel erudrr my jurisdirlion and Ihtc rrparl is True to !hr Lr.V <br /> of ray knorulydge and belief. <br /> 11<psh at whirh ,eater was first foread, if known <br /> )xanJin4 leve] he fort prrfn ra tiny„ if known (t. NAM 1- C-7/ <br /> i rz ndinq Icvcl xftcr prrfontinF nd dr,•dupvng ft. (,'-wp.frm,nr torpor- nl (T I,d pr f-,t,d) <br /> ell <br /> (10) WELL TESTS: Address �t�� <br /> Was pump trsr rnaJr? Ycs Na _ I y by who <br /> Yield: zal.lmi ft.drawdown after hos. [SIGNCU] <br /> 'Crm pu ra wee ul wstrr a rn analysis made? Yrs [I N. ❑ <br /> \W'aa electric Ing n adc of ell? Y, � Nn F-3 if yes•attac1,copy License No. Dated <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 LREV,b-sae zs„y_,su -cn soN Tu,r�o osP <br />