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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 N0. 2 5 7 ,30 4 <br /> �e of Intent No. _ _ State Well No. <br /> ' xal Permit No.or Date Other Neil No. <br /> (1 f]7'�l .1�Cf t��1RcN <br /> (1) OWNER: Name uSA, tuC �,VC <br /> r (1?) WELL LOC: Total depth ��' ft. ompleted dv, <br /> epth ft. <br /> Address 2 10 CAN ;IVO P-A KOW Q from Ft. to ft. Formation (Describe by color. character, size or material) <br /> 'City 5*!n/ Ahl CA/ CA 7.1P514 5,93 _ <br /> O • 7 <br /> (2)"LOCATION OF WELL (See instructions): <br /> County` + tt ,..._ _Owners Well Number <br /> Well address if different from above�s' As21b I A( 6 W,1 5TUCt4i en. `,_• 7 `7 G a.a. y <br /> Township Range cttian 1 <br /> Distpnee from cities, roads, railroads, Fences,etc. �✓L? e a r'�' �u v — c44-it'L4 <br /> tLf8Lee e.) o F 50e4_0 — ZO.� J� 4t 5au� o��u •� 12 <br /> 2dl — Cts µe SQL, t t..ow,.r wt`�� <br /> (3) TYPE OF WORK: (v f{"" S <br /> New Well Z Deepening ❑ 25'. = O 5,A 4 ef "CLW9t ar {OV'06-k- vyi <br /> Reconstruction ❑ Sri �S` <br /> Reconditioning ❑ .� —� ��� � � � �y4 ��y, <br /> � tva Horizontal Well ❑ <br /> 5 S y 1 f <br /> T,111 Destruction ❑ (Describe <br /> destruction materials and pro- Liz <br /> d cedures in Item 12) u <br /> ' (4) PROPOSED US _ (' •z� !\ \n,' <br /> Domestic <br /> Tv+,Tl Lt t7 Irrigation <br /> { Industrial ❑ C ` <�.�\`�J <br /> Test Well �� ❑ <br /> 1 _ W` <br /> IsQt t•] Munici <br /> AlG 1 r ❑ <br /> O erre <br /> ' WELL LOCATION SKETCH ( ` ) <br /> (5) EQUIPMENT: CRAY CK <br /> Rotary ❑ Reverse ❑ No <br /> Cable ❑ Air ❑ ete of bore r 7 ! l <br /> i <br /> 110"Other <br /> l9 Bucke c romt o <br /> Cl — <br /> 1(7) CASING INSTALLED: (8) I)ER TE _ <br /> steel ❑ Plastic n Ty ofo 'on or size of Q — <br /> From T QGage or t — <br /> ft. f ii Wall t. size = <br /> q, w e�L y 40.020 <br /> (9) WELL SEAL: <br /> .I Was surface sanitary sea!provided? Yes No ❑ f f yes,to depth 2�f R. — <br /> I, <br /> Were strata sealed a ainst pollution? Yes ❑ No X Interval ft. <br /> Method of sealing t WfCa,.�c C •"t�-• ►v�� Work started f 9 Completed l9 <br /> I <br /> (10) WATER LEVELS: 36 WELL DRILLER'S STATEMENT; II <br /> Depth of first water,if known <br /> -36, 1 ft.7 This well was drilled under my jurisdiction aced thi rypnrt is hire to the <br /> Standing level after well completion ft. best of ma <br /> y knoteledge nd L licj. <br /> ' (11) WELL TESTS: signed z� 1 <br /> Was well test made? Yes ❑ Nn ;§ If yes,by whom? (W ll Driller) + <br /> f test Pump ❑ Hailer ❑ Airlift ❑ NAME f5,4 E`s t ' �' t " - <br /> .)water at start of test Ft. At end of tt5t ft. (Pr m,firm. rporation)ITy�1 ur printed) <br /> urge ga!/min after hunts Wa[+• emperature Address z 1g- + M Y iQ E Sr <br /> 1',(.'11(!FniC3lAnaly.9iSlTlade? Yes No ❑ If yes,by whom?rrfC G L,4x' {Jty STC. G I fT�IV G" %!P . Z�✓ <br /> jf6f 5.y <br /> Waselectric logmad, Yes f� No [X If yes,attach copy to this repent license No. � 7 7 Doh;of lhti rf•Ix)rt 1 i <br /> IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 4WR 188[REV. 12-961 86 96353 <br />