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STATS 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. 2573110 <br /> s c(If Intent No. '• State Well No. <br /> l'1se:t[ I'urrnit No. or Date g$ $s Other Well No. 02 <br /> ''(I) OWNER: Name 11400' 05* l/vG (12) WELL LOG: Total depth__6 ft. Completed depth-39. ft. <br /> Address (D C*Mf'AI6 kZ,4L from ft. to ft. formation(Describe by color, character, size or material) <br /> 'City SkAt RA naw 7,11' � C� —Z � c! <br /> (2) LOCATION OF WELL (See instructions): — S s<« <br /> County $&✓t JI 991 IA Owner's Well Number MtN 8 — <br /> 'We'll address if different from above q'J 4et 5fv,-L,'-M <br /> Township N Range Section ! <br /> Distance.from cities, roads, railroads, fences,etc. OF — <br /> L1iLs tn1 33 <br /> — <br /> QP 19 CWXlrL-r— 4W LCL 9P .4 — <br /> 9D CIAE d>e PAa a p - o <br /> • N (3) TYPE OF WORK: — <br /> ' New Well [0 Deepening ❑ <br /> Reconstruction ❑ <br /> r Reconditioning ❑ <br /> Horizontal Well ❑ — l r� <br /> t Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> 1 (4) PROPOSED US \� � �) <br /> ` Domestic <br /> _ irrigation U <br /> Industrial ❑ n �, \�J <br /> Test Well � ❑ t\ \d) v <br /> Munici!t�-) EJ <br /> Oo (00 O er WELL LOCATION SKETCH ( t ;' <br /> (5) EQUIPMENT: (Tal CRAV f CK: \C� <br /> Rotary ❑ Reverse ❑ ®� Nv <br /> Cable El Air ❑ etel of bore 1 <br /> �, 22- <br /> Other [� Bucke ,�c1t€d rem <br /> /tV rcQ VV — <br /> (7) CASING INSTALLED: (s) PER 4TI _ <br /> Steel ❑ Plastic ® n Ty of fo "on or size of Q _ <br /> From T i . Cage or t <br /> ft. ft i Wall t. size — <br /> IWELL SEAL: _ <br /> as surface sanitary seal provided? Yes (;5 No ❑ If yes to depth " ft. <br /> Were strata sealed against pollution? Yes ❑ No 0 Interval ft. — <br /> Mohod of sealing Work started 19 Completed I 19—#-2_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> .•- 3S-3 6 f>� <br /> Depth of first water,if known ft. <br /> This well was drilled underl rr . "uri.sdec on and 0 , re rte tr e+lo�'the <br /> Standing level after well completion ' S8 ft bust of rnty knowledge and boli: <br /> WI1) WELL TESTS: Sigliceb I <br /> as well test made? Yes ❑ No V If yes,by whom? Well Driller) <br /> "gL <br /> f test Pump ❑ Bailer ❑ Air lift E3 NAME E67""Al <br /> wateral slamoftest ft. Atend of test R (Person,firm,or corporation)( yped ar printed) <br /> hm <br /> ehern,.,l <br /> gal/min after hours Water ter perature Address 2 Z Mcylc� Sf- <br /> analysis Elmade? Yes N No If y':s,by whom? City, / �` ZIP 9S s <br /> as rlre.,ri,,Ing made Yes ❑ No A If ves,at taoh crgry to this report License No. 22`� Date of this report 1 Z <br /> IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 'O WR IRB tREV. 12-845) IF <br /> 96355 <br />