Laserfiche WebLink
' STATE OF CALIFORNIA �'`t�[ v(pE ID <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> 1 WATER WELL DRILLERS REPORT N0. 2 5729'9 <br /> lt��e of Intent No. State Well No. <br /> ' _.,.gal Permit No. or Date -- 2 S Other Well No. II NA AF <br /> A) OWNER: Name �1 S f? 1 Nf 0 2) WELL LOG: Total depth Ft. Completed depth 7L' ft. <br /> Address (o Cv!}M t ti M from ft. to ft. Formation (Describe by color,character, size or material) <br /> city :58"', 1'1C ri C!a ZIP9Ll 57F3 <br /> _ 1 S� �.i 4. e i Q tti �ro <br /> '(2) LOCATION OF WELL (See instructions): — ZU S" a(i•,re vo- <br /> County Owner's Well Number 11 W6 <br /> ,Well address if different from abovef'?55' 4AI�WC- �re C IO — 3� �L 1 ,j ' i"w <br /> Township Range Section d — ?7� C�L <br /> Distance from cities, roads, railroads, fences,etc. �J ! — ` �� <br /> ft to <br /> (3) TYPE OF WORK: — <br /> New Well V Deepening ❑ ` <br /> Reconstruction ❑ <br /> �H�Vf2 dN C Reconditioning ❑ <br /> horizontal Well <br /> Destruction ❑ (De-scribe <br /> U destruction materials and pro- \� <br /> > cedures in Item 12) �\ ) <br /> `Q U (4) PROPOSED US _ <br /> Domestic <br /> k Irrigation <br /> � Industrial ('� ❑ n <br /> I Test Well \v\ ❑ 1�\\Q-} v <br /> er SRL TChz t tkX \D- <br /> WELL LOCATION SKETCH \ tbe) <br /> t5) EQUIPMENT: GRAVCK: <br /> Rotary ❑ Reverse ❑ No <br /> Sjizet <br /> Cable ❑ Air Elmet of bore "" r� r�\\ I 1 <br /> \� }� <br /> i-other Suck ed from tv�� <br /> � n - <br /> d 7) CASING INSTALLED: (B) PER <br /> AT1t11V5: _ <br /> reel ❑ Plastic ❑ n e Ty of Eo 'on or size of Q <br /> From D' Gage or t — <br /> ft. f Wall t. size <br /> t) WELL SEAL: �( _ <br /> as surface sanitary seal provided? Yes No C) If yes,to depth ft. <br /> ere strata sealed against pollution? Yes ❑ No ❑ Interval ft. <br /> Method of sealing Work started I / �' 19 Completer! <br /> 10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> epth of First water,if known Et. <br /> —� This rvell was drilled underuty jurisdiction and thins repo true to the <br /> Standing level after well completion Z- a ._,.,._,.__..,,,_ It. best of my kiiowledge and ix•lkpf, YTF <br /> Ell) WELL TESTS: )-User <br /> �Signed <br /> Vas well 1e151 made? Yes ❑ No Rf EE yes,by wham? r �I elk Driller) <br /> -".:-ter <br /> test Pump ❑ Railer ❑ Airlift ❑ NAMF(�il?} 1�N� til i 1VL� (i(JC. Px C'Tle e �`� <br /> o water at start of lest ft. At em of test ft. �+ rson.Firm,nr/�`' tin T d or rinted) <br /> ` are gal/min after hours Water r rature Address 2C 2' _ e' M �Fr e)1 yST-p <br /> t; n <br /> :hemicalanalysismacle? Yes No El If yes by whom? <br /> "` G City STec�7o N �� 7lPz� s <br /> as electric hog made Yes ❑ No PO IE yes,attach copy to this report Licenw No. _A 5�5 Z c Date oft his report l F <br /> IF ADD171ONAL SPACE IS NEEDED, USE NEXT-CONSECUTIVELY NUMBERED FORM <br /> WR 189 tREV, 12-66) 56 96355 <br />