Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA <br /> Use to comply with THE RESOURCES AGENCY Do not fill in <br /> local requirements e� DEPARTMENT OF WATER RESOURCES No. 129420 <br /> Notice of Intent No.159628 WATER WELL DRILLERS REPORT <br /> r <br /> Local Permit No. or Date State Well No. <br /> ' <br /> Other Well IVo. _ <br /> (r) owxx Claudeickes 2 -- <br /> r,Nan' (12) WELL LOG: <br /> • L'• Total depth ft. Depth of completed well ft. <br /> 31 <br /> Address <br /> City from ft. to ft orma ' n Descr' by color, character, size or material) <br /> � � <br /> Zip JL <br /> - <br /> (2) LO I uj*L , (See instructions): - <br /> County Owner's Well Number Well address K dil2rent from above58 S <br /> ----------4 <br /> TownshiP i• Rannjge_ yrction <br /> Distanc� rgl �ray��3c�1 c'P1J yi b _ _ <br /> •w�3ss iCi V112 _ i, <br /> ock- <br /> L ; <br /> (3) TYPE OF WORK: 164 - 1AS Gre, ejay <br /> v <br /> New Well 7� Deepening ❑ 18,1 <br /> - 20a Tiara brijtle p.r <br /> Reconstruction ❑ 208 - <br /> Reconditioning ❑ 216 <br /> _ n <br /> Horizontal Well ❑ _ 243 +r <br /> r <br /> Destruction C] (Describe - Packed ay <br /> destruction materials and 248 252 <br /> procedures in Item 12) - <br /> 260 <br /> 252 w <br /> (4) PROPOSED USE: 4 - 264 C l and gravel <br /> Domestic ❑ 264 <br /> 4� 288 Dr wnclay <br /> Irrigation 288 - 292 Packed Sand. <br /> Industrial ❑ 2 - 08 crown CI.a-v <br /> Test Well ❑ { $ - 12 Black sand <br /> I <br /> y <br /> Stock ❑ - <br /> Municipal ❑WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (6) GRAVEL PACK: proper we C QY er was ins tall ed on <br /> Rotary ❑ Reverse ❑ Yes ❑ No 4 Size_ V-11sa.—nd I ars not respans e <br /> Cable EP, Air ❑ Diameter of bore _ - altering or removing <br /> of the <br /> Other ❑ Bucket ❑ Packed from _tri___ Ft. — casing. <br /> (7) CJ§ING INSTALLED: (H) PERFORATIONS: - <br /> Steel ❑ Plastic ❑ Concrete ❑ Type of perforation or size of screen <br /> From To Dia. Gage or From To Slot - <br /> ft. ft. in. 11,all ft. ft. Size - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑ No If yes, to depth ft. <br /> Were strata sealed against pollution? Yes ❑ Noyn Interval __ft. t8 09?8- <br /> Method of se ling Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known flit ft. This well was drilled under my jurisdiction and this re,,,. 1 tn�the best of my <br /> Standing level after well completion ft. knowledge and belief. <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes F] No'g p If yes, by whom? FanePe Ideli"bAiiin; Inc• <br /> Type of test Pump El Bailer ❑ Air lift ❑ NAME •^A <br /> Depth to water at start of test ft. At end of test ft ( on mi,,,r ra p r ted) <br /> Discharge eal/min after hours Water temperature Address <br /> l: $ Q j S • <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by w _ ) , 70 <br /> Was electric log made? Yes ❑ No ❑ If yes, attach cf p'to I is�.r$p6rt-1 LYccnse o Date of this repo <br /> DWR 188 (REV.7-76) IF ADDITIONAL SPACE Ik,,�EEDED, USE NEXT C CUTIVELY NUMBERED FORM <br /> MiiAY 1719x8 <br /> sAN JOr.Q_11,1 LCGAL <br /> UCAl TN nfSjRICT <br />