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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY. Do not fill in <br /> 1File With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N4. 257300 <br /> V of Intent No. Slate Well No. <br /> i t. ;tl Permit No. or Date ' 2� j Other Wel[ No(l) OWNER: Name Ct IE�/r2�^1 f� (12) WELL LOG: Total depth _5 -2, ft. Completed depth 2•' ft. <br /> Address 2—�4 1,3 C.tt}r t l I • J 6fi Q <br /> from ft. to ft. Formation(Describe by color,character,size or material) <br /> City S 4 ZIP9[ <br /> f . 5cju� Lis �L awts wowu <br /> 1(2) LOCATION OF WELL, (See instructions): <br /> Gounty Srl�,1`J C Owner's Wgll Number Ni V4 <br /> Well address if different from above 5 <br /> �4,1j0i NG- `��OC-JeM N — 19-5 G`CZ� u E.� �>L4 v,�CJLt SCt4 r <br /> ,Township ) t'l Range E Section Llax — a� <br /> Distance from cities, roads, railroads, fences,etc. 3 q' — Z ' e_r u <br /> S <br /> (3) TYPE OF WORK: 7 — r- ✓• t u u ,`J i V✓? [re_.c_ <br /> ' C D rj New Well 9 Deepening ❑ Ll <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> C3 Horizontal Well ❑ l� <br /> , Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> (9) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial ❑ <br /> a f Test Well ❑ �G <br /> tiAR�I NCT L Munici 1 ❑ �� — /�1 !�� <br /> O er{I Oi2e/�J� �/ �✓ <br /> WELL LOCATION SKETCH <br /> (5) EQUIPMENT: r C1 <br /> CRAY CK: <br /> Rotary ❑ Reverse ❑ No izR �F�r y i^�1`�7�� <br /> Cable [I Air ❑ te eof bore <br /> (7) CASING INSTALLED: (8) PER TI _ <br /> teel ❑ Plastic n Tyof f on or size of Q _ <br /> From T i.. Gage or t . <br /> ft. f i Wall t. size <br /> WELL SEAL:IF <br /> as surface sanitary seal provided? Yes � No El ves,to depth 25� ft. <br /> Were strata sealed against�°11 ti ona Yes ❑ No X interval ft. - <br /> -Method ofsealing g.sa "e Work started G` 19 Completed f 19 <br /> 10) WATER LEVELS; -3 6 WELL DRIL ER'S STATEMENT: <br /> pth of first water,if known ft. <br /> �j ?)tom This ivellf rn kn drilled under iY[y ftlTlBdtCt[OTl and th s re}rort i.K}[rue to the <br /> Standing level after well completion ft. }x.'st Of mP krtUw}edge and Belief. <br /> 11) WELL TESTS: F�LA.1 <br /> �j signed <br /> Iris well test made? Yes El No ^ If yes,by whom? Well Dril[rT) <br /> of test Pump ❑ Bailer 1!3 Air lift ❑ NAIVE "&tNrEE.2lN6 1NC 1 <br /> +a�GT��1 M <br /> o water at start of lest ft. At end of test ft. 1(Person,Eirm nr en ration)(T or Printed) <br /> AddressZ92� G• <br /> k` arge gal/min after hours Water tem _analysis made? Yes No ifves,hywhom? jrG 0tv 5T0(=_V_10ti CIS ZIP F Z0 <br /> as electric log made Yes ❑ No d If yes,attach copy to this report License No. 5-7 5 •Z 6 2 Date of t his report I I [ <br /> DWR ISO(REV. 12-961 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 96 96355 <br />