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Do Not Fill In <br /> STAf_OF CALIFOANIA <br /> THE RESOURCES AGENCY <br /> cRiGINAL DEPARTMENT OF WATER RESOURCES N2 116662 <br /> Flit with VvM State Well No. <br /> WATER WELL DRILLERS REPORT Other Weil Na,_7_%-600--W- <br /> (I i) WELL LOG. <br /> OWNER: (I <br /> Name <br /> Address0rQ q- Co <br /> 0 <br /> (2) LOCATION OF WELL: -4,5 <br /> 16 – <br /> _S nn —32 16 AjjnA <br /> T_I <br /> Disesner from rite., <br /> 60 – <br /> MI: rntlasa <br /> w <br /> (3) TYPE Of: WORK (check) 76 – 0 17r1ttle cla <br /> ❑ Reconditioning C Destroying [3 <br /> New Well So 84 and <br /> (5) EQUIPMENT: 84 16 bMyn_g_�� <br /> (4) PROPOSED USE (check): <br /> Domestic F1 Industrial [I Municipal [_1 Rotary <br /> Irrigation [2 Test Well Other ❑ Cable <br /> Other <br /> (6) CASING INSTALLED. if gravel packed <br /> STEEL: OTHER! <br /> SINGLE M DOUBLE <br /> Gage Diameter From <br /> Frtsm or of <br /> Diim. Will Bore ft. ft. <br /> 0 _10Q 12 <br /> b 6 10 <br /> f h� <br /> 0!­t-want B t we A rolDer seal was installed on thiswell <br /> SCREEN: an altering <br /> (7) PERFORATIONS OR am not r nal.ble fo <br /> LRan qAR2A_ . <br /> and <br /> or removinE_of the Be Lal or casinE-c— <br /> Rows <br /> To per per Size <br /> Front row ft. in.x in. <br /> .......... <br /> CONSTRUCTION: 52 <br /> M N". <br /> Work <br /> iwm h.su ement n ELL DKILLER'S STATEMENT: he brit <br /> mok'd w.FamehTho; Uelt uds jrlllcj�,Hjer my iurisdiroar,and ibis rrPurl is ItIrc 10 1 <br /> (9) WATER LEVELS: 20 my knorg ledxv and brlirr!. <br /> As's f.-nd.;f�nvwn <br /> LJqp1h at NAME <br /> Addr,,, <br /> (lo) WELL TESTS: a <br /> If b, h­? <br /> 7' <br /> tiv It LA_­KPr __A <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE: <br /> err la.i90 9.Y!adM leer(sre., <br /> r.lv%" lots <br />