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7EPAFU <br /> � <br /> C /.r� <br /> r e�LtYa Do Not Fill In <br /> STATE OF CALIFORNIA 6� <br /> WHOM" 4V� THE RES&URCES AGENCY C-1 No� 15115 4 <br /> In*with owe TMENT OF WATER' RESOURCE { r <br /> WATER WELL DRILLERS REPORT 9i s` well No <br /> L = �C• �O Ocher Well No <br /> n <br /> t� <br /> (I) OWN R: (11) WELL LOG: r, �• �� <br /> Na I Jya'Y Total depth ft Depth of completed vel] 4t <br /> Ad cess Formation Dnrrrbr by rotor r6aracirr use of marerul and strucrurr <br /> t:f 4 Q <br /> fit. <br /> ft <br /> ONF WELL• ✓��� 4 <br /> 11 w r s number if any <br /> ownshi9 Ransr and Zg� <br /> pounce from cues roads raJraads ere t <br /> •� <br /> (3) TYPE OF FORK (check): <br /> New Well Deepening ❑ Reconditioning ❑ Destroying ❑ L <br /> if destruction describe materraf and i[orrdAlito Jte+n I I <br /> (4) PROPOSED USEec1�J_`�- 5- (f) EQUIPMENT: <br /> Domestic Eq-,XFx-GttfaT ❑ Munlclpal''{]E Rotary <br /> Irrigation ❑ XIst Well ❑" 'Other [] Cable ❑ �'-- <br /> Other ❑ <br /> (6) CASING III ` LE };,` _ afi 1 1— <br /> If gravel packed <br /> STEEL OT14ER <br /> SINGLE R�/�UBLE ❑ <br /> Gage Diameterc <br /> From 10 or of From To <br /> ft It DO Wall Bore ft . ft <br /> .-.. <br /> Sue of,hoe.,r w r Size of travel >� � ~ <br /> -. o -A <br /> Docnbe s.n^ �. <br /> (7) PERFORATIONS OR SCREEN: t� <br /> Type of pectu TA lean or name of screen <br /> Perf Rows <br /> From To per per Size <br /> k ft row ft in x in <br /> A±n2 <br /> ` L <br /> (8) CONSTRUCTION <br /> Ws a,urtaca>anenry seal prov,ded' Yes 200 To what depth ti-% ft <br /> Were any,irna,,,led apen,r poll,,,oy' Yes❑ No❑ !f yea note depth of er ran <br /> IFrom (r ro ft <br /> From t m ftWork started 19 Compiet 197 <br /> ' WELL DRI ER s STATEMENT <br /> Method of waling <br /> This urll was drilled uredrr my inti rr and this repo lint to tfjr¢ast <br /> (9) WATER LEVELS. of r?ty knot rd and belief —� r* <br /> uepth at which water was first found of known t J <br /> >nnding leve! before perforaung if known ft NAM <br /> n firm eorporat [T d or prrr ed) <br /> snndsng level after ptrforathnit and developing - ft Y <br /> (10) WELL,TESTS. Addres <br /> a pump test made? Yea {] ti No 6--']1 yn by-h-nal a <br /> dy <br /> gaE Irvin with �ft drawdown after hrt <br /> ,,� (IVT!!prr[[n) <br /> rmperature of water Wis.chem.cal analysis made? Y. E] No RP-- <br /> Via alectnc last made of well? Yes © No Z��If yes attach copy Date 19�� <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> OWR ISO tREV 4281 _ 1672 SON TairUlrour <br />