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ORIGINAL WATER WELL DRILLERS REPORT Do Not FxU In <br /> Pile with DVM (secttana 7079,7080,7091,7082,Water Cads) N9 <br /> 43088 3 O 8 Q <br /> THE RESOURCES AGENCY OF CALIFORNIA to-gn �]l7 <br /> "4'�'«�L LOG DEPARTMENT OF WATER RESOURCES state ellNo <br /> N,,.¢NL _3� (- , <br /> Va-�er Ude Sec. 1.4752 OthrW <br /> (1) OWNER- (11) WELL LOG: <br /> Name Emerson Fierrick Tota]depth 460 ft Depth of completed well it <br /> Address a18 West Pine <br /> StZget <br /> Formwiuoa Drsnibe by color rbaraeter,me of materml sod st"wtarr <br /> T.gdl , Ggli-fornia Tom M11 <br /> (2) LOCATION OF WELL: 1Z------_ <br /> County 3an Ljoag3iin Owners number if any -- — j K ia <br /> Towashtp Ran a and Section T4X RA W 3 A a t i Q n 30 -------SA t <br /> Datance from cotes reads railroads e —a.,r---.. <br /> ft Snf SA 91 __ <br /> 1 —� <br /> (3) TYPE OF WORK (check): ------ <br /> = --= <br /> New Well � Deepening ❑ Recoadlttonxng ❑ Destroying <br /> ..—:Licw "' <br /> If destruction,doses:br material and procedure to Itrrx 1! — <br /> (4) PROPOSED USE (check)• (S) EQUIPMENT: 173----=7 <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ ----{ do <br /> Irrigation {M Test Well ❑ Other ❑ Cable [g 1 <br /> Other ❑ «-----= S <br /> (6) CASING INSTALLED. — L= <br /> STEEL OTHER If gravel packed 2 x + <br /> SINGLE DOUBLE NO — <br /> r= i <br /> PA 2 St <br /> Gage Diameter ____ � <br /> From To or of From To —� <br /> ft ft Btam Wall Bore ft. ft ---- <br /> 36Q 12 12 Sla <br /> rr_—wwy— } <br /> Sae of shoe or well ring �1t Sire of tr.vel m—r—b3, <br /> Describe lotoc All Siantric, pittt --_— <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of gerforauoo or Dame of screen — <br /> me d-, nwalb gAnd <br /> 3?1rr_--7r <br /> Peri Rows <br /> FromTo per per Siu —*"'--� <br /> ft ft row ft to xin ...��_—'— IV <br /> _.tS d- <br /> 425------ anc <br /> ea gravel. <br /> 428---- '-435 brown <br /> (8) CONSTRUCTION 435 <br /> Was a outface satntary ual provadedT Yn 10 No Cl To what depth <br /> Were any strata sealed a;atnsr polluc,on? Yes❑ N-M If yes note Aept3 a strata <br /> From ft to fe — <br /> From it to ft Work 3,D 19 Completed la C rin 19 <br /> Method of ashnR WELL DRILLER'S STATEMENT <br /> This well was drilled under my jurisdiction and this report is true ty tb9 hest <br /> (9) WATER LEVELS: of my knowledge and belief <br /> Depth ac wh,ch wear w.3,fiat found if known 9A it <br /> Standing level XNNAMaWN&L <br /> + fr NAME li <br /> (Person,firm,or earporaao9) (TyArd or Printed) <br /> Standen level after rforattnR anti developing ft <br /> 10) WELL TESTS: Address <br /> pump enc mad6) Yea ❑ No X It yes by whom? <br /> old ;al/mm wuh ft drawdown after <br /> lire SIGNED <br /> Wrll DrlHnJ <br /> Temperature of water Was a chemical aaalyus madei Yes ❑ No <br /> y, 19 <br /> War eleetnc IDR made of well? Yes Q NoAI If yes atpeh copy L 249 36 Dated <br /> 1CtII3,e No, <br /> 41 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE _ <br /> 363,91 Iso to 13 saw Tett©A Osr <br /> r,lal e) �On ne�1 n Fl�1 <br />