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71.L LQ <br /> altIGINA WATER WELL DRILLERS REPORT Do Not Fal In <br /> Fila with DWR {sections 7079,7080,7081,7097,Water C-,-1,j N° 44215 <br /> THE. RESOURCES AGENCY OF CALIFORNIA <br /> State Well No. <br /> DEPARTMENT OF WATER RES0U R:--=5 < <br /> Other Well N �O <br /> '(1) OWNER: (11) WELL LOG' <br /> Name aL— / Total depth f ft. Depth of completed well YO ft, <br /> Address Formation: Derrribe iv r :easter,size of msleriai,and rfrcrtwre <br /> 5 0 ft.to ft. <br /> (z) LOCATION OF WELL: /S- <br /> County - Qwnrr's number.if any (�— <br /> 'Township.Range,Xid Sec on <br /> Distance from cities,road,,railroads,etc. <br /> '(3) TYPE OF WORK (check): �/.�,,,e,, 1J <br /> New Well ❑ Deepening ❑ Reconditioning ❑ Destroys g ❑ <br /> 11 destruction,describe material and proredure in Item 11. <br /> '(4) PROPOSED USE (check): (5) EQUIPMENT: <br /> Domestic g Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable 12 <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> If gravel packed <br /> STEEL: OTHER. <br /> SINGLE ❑ DOUBLE ❑ <br /> Gage Diameter <br /> From To or of From To <br /> ft. ft. Diam. Wall Bore ft. £t. <br /> d 6 1zo <br /> /,, <br /> Size of shoe or well ring: 6 � Size of gravel: <br /> ' Describe joint <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perforation or name of screen <br /> ' Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> (s) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes ❑ No❑ To.chat depth ft. <br /> Were any strata sralcd against pollution? Yes ❑ No❑ If yes,note depth of strata <br /> From ft.to (c. <br /> .{ 7 <br /> From ft,to ft Work started ..!-' '�'G ,Completed .�-•�c l9 <br /> Method of,ealinq WELL DRILLE[t', TATEMENT: - <br /> (e" WATER LEVELS: This well was 1.1r-1i ,i :oir;Irr my jurisdiction and this report is true to the best <br /> / S o}my knowled a arr.1 <br /> Depth ac which waur was first found,if known (Q�+ ft. i�J,!,... rel I R r rj C�. <br /> 1 1 <br /> Standing level before perloratiag, if known Ft. NAME <br /> ,i'.:.on,firm,or corporation) (Typed or prialyd) <br /> ' <br /> 5tanding tevel after perforating x-I'developing it. <br /> {1(1) WELL TESTS: Address %> . J ,� t��2al <br /> ++ -,mp tat made? Yer Q No ❑ If yrs,by rhom7 <br /> \�' <br /> gal.Jmin.wish (r,drawdown after hrs. [SIGNED] <br /> rature of waur Was a ehemidl aaYes (Well Drif <br /> al sir made? Yes ❑ No ❑ <br /> Was electric log made of well? Ye ❑ No ❑ If Yea,at each copy License No, "are , 19 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE rte <br /> DWR 1158 IREV, 9.65) Z� 56aYt-94010•e74aM 7RI�Q�Ga� <br />