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- STATE OF CALIFORNIA — <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> 1 File with DWR DEPARTMENT OF WATER RESOURCES - <br /> WATER WELL DRILLERS REPORT No. 313814 <br /> ice of Intent No. + ,07fS„� State Well No. <br /> ' Local Permit No. or Date�� �� �--Q/ / Other Well No. <br /> (l) OWNERNam- +� T ' (12) WELL LOG: Total depth ft. Completed depth ��ft. <br /> Address From ft, to ft. Formation (Describe I)v color,character, size or material) <br /> ' City 7.IP = 6i <br /> (2) LOCATION OF WELL (See instructions): <br /> County-:5�5W IrA' a'al Owners Well Number — `J— <br /> Well address if different from above <br /> Township lunge / -� ,--Section !— t1 - <br /> Distance from cities, roads, railroads, fences,etc. <br /> i <br /> — r h <br /> (3) TYPE OF WORK: <br /> ' New Well ❑ Deepening ❑ - <br /> Reconstruction ❑ C1 a r <br /> Reconditioning ❑ <br /> Horizontal Well ❑ — / \ "v/v <br /> 4A raw wl f Sfi Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) 1 <br /> Ui4iflGR -c-.Kia twcti �4) PROPOSED USFf. <br /> ' Domestic <br /> Gt Irrigation L 1 ", <br /> Industrial <br /> Test Well 1 El <•� �� `� <br /> J <br /> ' Munici4\ J ❑ l• i <br /> OAer LJ. <br /> WELL LOCATION SKETCHbe) <br /> (5) EQUIPMENT: (�Bk CRA EL``A,��CK: <br /> Rotary 11 Reverse ElYAs Noi Size <br /> ' Cable #J Air ❑ ete f bore — <br /> Other ❑ Bucke c .d from — <br /> � <br /> (7) CASs G INSTALLED-. (8) PER TIS$ <br /> v Q <br /> Steel ElPlastic K n Ty of fo 'on or size aF r <br /> From TiQ Di Gage ortllt� _ <br /> — <br /> ft. f i Wall t. size — <br /> 1 ' — <br /> (9) WELL SEAL: I <br /> Was surface sanitary seal provided? Yes fA No ❑ If yes,to depthr ft. <br /> Were strata sealed against pollution? Yes ❑ No [9 Interval ft. - <br /> o Work started '~ l9 completedl__-9", i9�/ <br /> ' 1`lethod of sealing <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft. <br /> /U rt3Q This well was drilled under my puns &:on an this report is true to the <br /> Standing level after well completion Q ft. lx.et of rrltf knot ledge nd lx'lief. <br /> ' (11) WELL TESTS: Signed <br /> Was well test made? Yes ❑ No ❑ If yes,by whom? I a ,,it <br /> oI test Pump El Bailer Cl Airlift C1 NAME <br /> h to water at art.test ft. At end of t+st ft. (Person 'mor cur ra[ (Typed or print <br /> isc'harge 1./min after hours Water temperature Address <br /> C:hrmiral analysis made? Yes ❑ No ❑ If yes,by whom? City04 %1P'! 7 r✓ <br /> Was electric log made Yrs Ll No ❑ If yrs,attach copy to this report License No. Date of this report <br /> ' <br /> 1F ADDITIONAL SPACE IS NEEDEo. USE NEXT CONSECUTIVELY NUMBERED FORM pyyp IBB{REV. 12-88) C� BD 914335 <br /> V <br />