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MAY 113E5 <br /> ORiGIRAL F <br /> WATER WELL DRILLERS,.REPQRT no Not F>rrr In <br /> Fib W th DWR (s.ccloaat y0Tl,yore,cost.ya>tia Mr s r Cada <br /> THE RESOURCES AGENCY OF CALIFORNIA N? _ 44966 <br /> r <br /> DEPARTMENT OF WATER RESOURCES 5utc Well Na <br />{ ` •� Colter Weil <br /> (1) OWNER: <br /> (1 I) WELL LOG: <br /> C 'total depth 12 j ft. Depth of completed well ft. <br /> Address �', :�• P:�'W 'l"'• Formation: Describe by color.rbarerter,ti=t al sefrr.W,a+sd arswture <br /> WLLL: i� 3 <br /> "�� w•4u rl a:A la <br /> (2) LOCATION_ Old _ f ` �- <br /> r y <br /> County _ r u.yZi Owner's nnm6er.if any L� <br /> .'�'. <br /> Towaakip.Raabe.and Section 2.:1 f :r s �:(,'a L r7� n _ EI <br />` u <br /> I <br /> Distinct from cities,rosdf,railroads,etc. n <br /> f >_:1 27 I U <br /> 1 <br /> (3) TYPE OF WORK (check): <br /> New Weil Deepening Q Reconditioning [I Destroying © I "1 Pv <br />' if destruction,describe material and procedure in Item 11. 111 ll-* DYriu 1 <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: ll 12:. 5 1 a - <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary & 1 c,l 1 711 <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ 1`i l t•, <br /> Other El <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLE DOUBLE <br /> Gage Diameter <br /> From To or of From To <br /> it. ft. Diann. Wall Bore ft. ft. <br /> V 1'l, a1J <br /> • ) 1 <br /> Size of shoe or well ri.g: Size of gravel: <br /> Describe joint <br /> .'Fl sed <br /> (7) PERFORATIONS OR SCREEN: <br /> type of perforation or name of screen `.fl21E <br /> Perf. Rows <br /> From To per per Size <br /> ft_ ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Was a surface saaitsry seal provided? Yes IN No❑ To what depth �0 ft. <br /> Were any strap sealed against pollution? Yes❑ No 40 If yea,nate dtpth of strata <br /> From ft.to ft. <br /> �7 <br /> From ft.to ft. �osk started Completed &p r 11 <br /> Method of aesiin G i—tel2e-' _;�" 1. out WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: Tbis wdl was drilled under my jurisdiction and this report is true to the beat <br /> DWI)at my knowlydgeand belief. <br /> at which water was first found,if known ft. <br /> 5cmdiss[< level before pedantinR, if known it. NAME 'T• E`a =����=n----' V V• <br /> Standing leve] after perforAting and developing ft. (Prean,firm,or corporation) (Typed or prNtted) <br /> 10) WELL TESTS: Addrm 7525 r•tsdre1 - Ave. <br /> amp test made) Yea I1 No ❑ If ret,by whom? Well driller a5 off+l.,tp l,f-,,.+JAI <br /> jlo xal.lsnin.with 1-+14 -ft.drawdown afterc - <br /> kris'-- $1GDt8D]s; 's a, <br /> Teaupersture of water Was a chemical snalyaia made? Yea ❑ No Gil (well Dr!lkrf <br /> Wan electric Jos made of well? Yes IT No [-I If yes,attach eo y Liomse NO —69656 T+steel_ April 25 <br /> SKETCH LOCATION OF WELL'ON REVERSE SIDE <br />