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' STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> ' WATER WELL DRILLERS REPORT No. 313825 <br /> u'eof Intent No. ^�Jn n State Well No. <br /> ' .neat Permit No. or Date -.��- -�Q e�~,$'�� r✓/ Othrx Well NeA <br /> (1) OWNER: Name (12) WELL LOG: Total depth_.M It. Completed depth ft. <br /> lrlcfre-`s From ft. to ft. Formation (Describe by color,character,size or material) <br /> City ZIP / <br /> tfl�01^ <br /> l s. <br /> (2) LOCATION OF WELL (See instructions): - 'r <br /> County.'a&jJ Z;aA •zr Owners Well Number, _ r <br /> Well address if different from above _ <br /> Township_ - I/!.) Range. $ectinn 2— 4LO <br /> Distance from cities,roads, railroads, fences, etc. / <br /> ti 9212 <br /> (3) TYPE OF WORK: r <br /> ' New Well ❑ Deepening ❑ 22240115 <br /> Reconstruction ❑ <br /> Reconditioning ❑ V <br /> f <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> r Vt! destruction materials and pro- <br /> cedures in Item 12) <br /> ' 9a (4) PROPOSED USE/" <br /> Albo,wnl?ar 41%) L)JC t( Domestic ;�.`\�}i .✓11, CJ <br /> Irrigation 7 <br /> -g <br /> Industrial <br /> Test Well �� \ ❑ !\\ <br /> Zer <br /> WELL LOCATION SKETCH <br /> (5) EQUIPMENT: (�) CRAv$LTtACK: <br /> Rotary © Reverse L] Yrs'❑ No\© Size r^� <br /> Cable ❑ .Air © ` meter of bore `• � / s ! l \ \U <br /> Other ❑ Bucke a ed from �tt> - <br /> V <br /> (7) (--ASIrr,INSTALLED: (8) PER ATII9N\ _ <br /> ' Steel ❑ Plastic an Ty of fo 'on or size of r 'n _ <br /> FromDi . Gage or t - <br /> ft E Wall t. size - <br /> 1 LIA _ <br /> ' (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes (81 No © if yes to depth /-.r ft. <br /> Were strata sealed against pollution? Yes ❑ No I9 Interval ft. - <br /> �p <br /> Method of sealing------AJj2.Aa Work started 19-1 Completes{ - 19 <br /> ' (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth of first water,if known_ -t'J� - -- ft. <br /> SDN¢ This well was drilled trader my jurisdic ion and f1 's report is true !o the <br /> Staudinglevel after well completion ft. hes!of"Iykno ledge and lxdief. <br /> ' (11) WELL TESTS: Signed , <br /> Was well test made? Yes ❑ No ❑ If yes,h)wham? (Wch filler) <br /> Agof test Pump ❑ Bailer F-1Air lift ElNAME AJ <br /> h to water at start of test h. At end of test ft. (Pe firm,or rvrpor ionl( ytxel or p 'r) <br /> barge gal/min after hours Water temprratura Adclres <br /> herrtical analysis made?' Yes ❑ No ❑ If ves.by whom? Cily zip :25,5 <br /> Was electric Ing made Yes ❑ No ❑ If yes,attach copy to this rrlxrrt License No. Date of this report J -� <br /> IF ADDITIONAL SPACE IS NEE.ED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> ' f]WA t EE IREV. 12-865 86 96355 <br /> 0 <br />