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ISTATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES 270805� O � Q <br /> WATER WELL DRILLERS REPORT SIO. <br /> Tce of Intent No State Well No <br />�i_.ocal Permit No or Date <br /> S( - ( Other Well No 61M10. <br /> (1) OWNER Name Pqt Indd (12) WELL LOG Total depth949 it Completed depth202it <br />,Address from ft to ft Formation(Describe by color character size or material) <br /> City zip _ <br /> (2) LOCATION OF WELL (See instructions) 1 -3 reddish brn cla <br />,County S O 111 Owners Well Number 3 -10 hard an <br /> Well address if_4iffqrent from above 10 -13 sMdy clay <br /> Township Range Section 13 -19 loose sand <br /> Distance from cities roads, railroads fences, etc X41 I 1 99 E t ftCkM 19 -53 VarlOus SaYI<d strata unstable <br /> North fence 60 ft. from NE scorner of home 53 -56 s:Lltj clay 'wit avel <br /> 90 ft from west rop 11ne 56 -83 one inch avel/ln cla <br /> 83 -90 cla \ some gravel <br /> E F0a V �� (3) TYPE OF WORK 90 -98 brn cla ��little silt <br /> New well KI Deepening ❑ 98 -121 brittle\clay mostly brn clay <br /> Reconstruction ❑ 121 -1M blbck sand and gravel to 2" <br /> Reconditioning ❑ 132 X145, brn ela /> <br /> Horizontal Well ❑ 145 -15T\ coarse sand and pea gravel <br /> � Destruction ❑ (Describe <br /> 15 \\-196 "brn -clay-- <br /> destruction materials and pro- 196 205 coarse black Sandstone and. Dea <br /> Cb cedures in Item 12) \ ravel <br /> �..tsyys�a (4) PROPOSED US 205 245 "'various clay s. .sand strata at <br /> Domestic :200ut-out ` d sand runs <br /> --r,,l i Irrigation Q ' '= leveling--out at 202. <br /> r Industriallie ❑ / ." Y <br /> Gest Well \ ❑ <br /> Mumci ❑ <br /> O er 0 �� _r �`/� Z-1 <br /> WELL LOCATION SKETCH <br /> (S) EQUIPMENT GRA V17k�ACK <br /> Rotary ❑ Reverse ❑ m No X1 Size <br /> -r <br /> Cable XI Air ❑ et of bore <br /> f _ <br /> Other ❑ $ackeJr-)� aclSed from to ft v — <br /> (7) CASING INSTALLED- ; %, (8) PERFORATIONS i^ _ <br /> ti <br /> Steel KI Plastic C] e ❑ Type of perforation or size of screen <br /> From Teo Dt� Gage or ` Firom To, Slot - <br /> ft fq In Wall f%-- --ftp • size <br /> 0 187 kA -196 <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes [ No ❑ if yes,to depth 120 ft <br /> Were strata sealed against pollution? Yes ❑ No 0 Interval ft — <br /> Method ofscaling �raVlt 011t Work started 19— Completed_NnAr 19. <br /> I — <br /> I (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth offirst water if known Et <br /> ?'hes well was drilled under m lurisdretion and this report Is true to the <br /> Standing level after well completion 117 ft best of my knowledge and belie <br /> (11) WELL TESTS Signed <br /> -0e 11test made? Yes ❑ No It yes,by whom? (Well Driller) <br /> f test Pump ❑ Bailer ❑ Air lift ❑ NAME <br /> to water at start of test ft At end of test ft lPerson Grm orcorporation)(Typed or punted) <br /> narge gal/mm after hours Water temperature Address <br /> Chemical analysis made? Yes El No ❑ it yes,by whom? City ZIP <br /> Was electric log made Yn ❑ No ❑ [f yes,attach copy to this report License No 391 549 - Date of this report <br /> OWR ISO IREV 12-ael IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br />