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CRIG� WATER WELL DRILLERS_ REPORT Do Not Fill In <br /> rile w DWiI (soctlmm,yoyl,7sao,rag 1,7022,pac+r .� TTS 47594 <br /> jf THE RESOURCES AGENCY -OF CALIFORNIA tate Well No <br /> � <br /> DEPARTME T OF WATER RESOURCES- -,L �f <br /> � �� t �� / ocher Well NofClrr�� Y <br /> i . <br /> (i) OWNER: (.ii) WELL LOG., <br /> E Name, Toed dcprh ft. Depth of tompieted well 74 ft. <br /> Address - Formation: Drscribr by rotor,cbaraeier,riar of[.atrriaf, wl strrcrrrr <br /> ftto ft. <br /> N <br /> (2') LOCATION OF WELL: ` 12 <br /> CeuntY Orner'a number,if in �- <br /> Township,Raaga,sad Sec a <br /> Dbtance from cities,roads,railroads,em. LL <br /> .ti <br /> i' (3) TYPE OF WORK (check): <br /> LNew Well Deepening M Reconditioning ❑ Destroying Q f — `^ <br /> if destruction,describe material and procedure in Item I I. <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: — 9 f� <br /> Domestic N Industrial ❑ Municipal ElRotary ® — /3 <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ — a" <br /> Other ❑ 1 b <br /> (6) CASING INSTALLED: <br /> If gravel packed <br /> STEEL: OTHER-. <br /> SINGLE ❑ DOUBLE ❑ <br /> Gage Diameter <br /> From To I or of From To <br /> it. it, Diem. Will Bore ft. it- <br /> Size of shoe or Well ring: J Site of Rravel: i t i !•'+y. -- <br /> Describe joint �- - - - y L !pprrt's <br /> (7) PERFORATI S OR SCREEN: <br /> Type of perforation or name of screen <br /> Perf. Rows <br /> From To per per Size <br /> ft. fc. row ft. in.x in. <br /> 3:0C nU <br /> (8) CONSTRUCTION: <br /> V7as s surface sanitary seal provided} Yes ❑ No 1A To ghat depth ft. <br /> Were any. anted against pallutien/} Yes No yes,nate depth of tcra[a <br /> From C' fc.to '+' It. 19 ! ,Completed U 19 '� <br /> From fs.to ft. Work seamcd - <br /> me[hod of aeilinR del � f� C �1`1' WELL DRILLER'S STATEMENT- <br /> This welt was drilled under my inritdiction and this report is true to the best <br /> (9) WATER LEVELS: of my knowledge and belief. <br /> i <br /> Depth at which rater ran first found,if known f`- NAME <br /> Wr�T <br /> standing level before perforating, if known it. r '�iaeay� <br /> i _. (Person,firm.or c idb3U I MY v d j <br /> Srxndiopt level sfur perforating and developing fz. <br /> '1415(i o) WELL TESTS: Address e. <br /> .m teas wide? Yn ❑ No ❑ If yn,by whom? <br /> m, .. <br /> gsi.Imia.wads it.drawdownsftu hn. ,. fIrr <br /> (WellDrlflrr) <br /> Temperature of wacet Wu a chemises analysis made? Yes 0 No 0 <br /> Was electric to made of well} Xn ❑ Ne ❑ If yes.attich copy Licenge <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> sorii-ago to-ag ROM TRI!QQ A osr <br />