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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY �T <br /> DUPLICAU DEPARTMENT OF WATER RESOURCES N? 99793 <br /> Retain this copy <br /> WATER WELL DRILLERS REPORT State Well ND. <br /> Other Well No. _71i—r_r. 2 r IJ <br /> (1) OWNER: (11) WELL LOG: <br /> Namea _ Total deprh ft. nepth of completed well It. <br /> A33 <br /> ddress q Forman..: Dnrribr by rotor,cb.rureer,nz of maenia1,and a...I., <br /> (2) LOCATION OF WELL: c <br /> Co.., San JonqiAn O. mb,r,if avy — C $ <br /> Township,Range,and Secrion — U f w <br /> Dlsrance from dries,rods,railroad.,etc. r r <br /> lilu , clav <br /> ORK ( <br /> (3) TYPE OF Wcheck.): 55?—t4 Blue Clay sand <br /> Rea Well�1 Deepening ❑ Reconditioning ❑ Destroying ❑ D <br /> If destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (f) EQUIPMENT: 1 — B lle C18 <br /> Domestic ® Industrial E] Municipal ElRotary RIrrigation F1Test Well E] Other E] Cable ❑ — c <br /> Other ❑ —10 Send—fair <br /> (6) CASING INSTALLED: fuF— .2nalea C Hy <br /> STEEL: a OTHER: If gravel packed c <br /> SINGLE DOUBLE ❑ 116-118 c 1 <br /> 11 —121 Clay & sand <br /> Gage Diamecer <br /> From 'Ib or of From To <br /> ft. Is. Duras. Wall Bore fa. ft. I It, <br /> 11+2— Cla & fine sand <br /> —i tty , and & Gravej- <br /> Riar.f ohne wd.cin.: b a of a .d: 1 —1 Clav & Sand <br /> Da ribrm., wpldprl —1 Z1, Clay <br /> kiallu <br /> (7) PERFORATIONS OR SCREEN: 91 Air <br /> Type of perfuraaiun or name of screen nf, 72 <br /> S <br /> Perf. Rows <br /> 172 173 Clay <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> 1 8'l 185 clau185 inn --earse sand <br /> 191 195 Gearse sand <br /> 195 212 Clay <br /> PIP 231 Gearse send/gpavel <br /> (a) CONSTRUCTION: 233 GlaY <br /> W..a.urLee uvirary snl provided? Yea No❑ To what deprh 100 fr. <br /> Wer any* Baled agai r pollut Yes ❑ No EJ If yes a depth of nnn <br /> From I,so ft. <br /> krvm f[.1. Ie Work snrted !7-1 1,!74 ,Completed 19 <br /> Method of anhne WELL DRILLER'S STATEMENT: <br /> ykwell .,as drilled nowledge andbelief.belefJer my jurisdiction and this report is line to the best <br /> (9) WATER LEVELS: of m <br /> Ueprh ar which wr .. fin. found, if known f[. <br /> Srapdmg lad bdureperfor—rg, if known ft. NAME <br /> enon,firm,or eorporanon) y e o r <br /> Standing le.el a@n perforating and developing 40 Ea. <br /> (10) WELL TESTS: Address - I) <br /> Was pump rear mase? Ym ❑ NoTl If yo,by whom? <br /> Yield: nl.lmin.Irish drawdown stmt hrs. [SIGNED] <br /> (Wdl D.il(rr) <br /> Tempeumre of waver Was a chemical amlyu,made? Yea (71N o <br /> War electric log made of wdl? Yes ❑ N If yea .rh copy License No. 7 Dated E3-1 8 19 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> D W R 188 1 RE V, 9.681 .1119-s.o 9-e.MM TR1I Ao o8e <br />