Laserfiche WebLink
RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> lie with DWR DEPARTMENT OF WATER RESOURCES No, 096286 <br /> rtf Intent No WATER WELL DRILLERS REPORT state Well No <br /> Peniitt No or Drte Other %%ell Yu L62--:f <br /> OWNER 11.3 WELL. LOG ��(J <br /> 10! �7'L \ � Tut r[dcp /� tt Depth of completed weEM ` �ft <br /> ""OWNER <br /> rens L tront ft to ft Formation (Desc be by color ch Lr-u ter }tie nr mnterml l <br /> i tvw - <br /> Lip <br /> (2) L AM OF WELL t See tn5tlilc hotu) _ t L <br /> rant <br /> Oi ner s Nell N ober <br /> rll iddresi if doff re it fr rhrrve to3 - f <br /> Toii nrht <br /> Sectio <br /> )stance from cities reads rtilmadh fences etc - <br /> _ 7.2- <br /> (3) TYPEOF ORK i <br /> New Well eepentnq ❑ <br /> �( l Reconstruction ❑ <br /> J <br /> Reconditioning [� 1.21 _ P.3 _ <br /> Horizontal Well ❑ ~ <br /> Destruction ❑ (Describe - / <br /> F destruuton materials and / <br /> M procedures in Item 12) - <br /> ei <br /> 4 �r <br /> 1 (4) PROPOSED USE <br /> ��/ �✓ Domestic <br /> Irrigation ❑ <br /> i <br /> Industrial ❑ - <br /> 4{} Test Well ❑ <br /> Stock E3 <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ - <br /> (.3r EQUIPti1Er1/ (6) GRAVEL PACK - <br /> itary Q// Reverse ❑ Yes Vo ❑ Stz <br /> tale ❑ Air ❑ Diameter of bore - <br /> Other ❑ Bucket Packed fmm <br /> Ll <br /> CASING INSTALLED (8) PERFORATIONS0 Pt15tie Concrete ❑ Tvpe of perforation or size of screen <br /> From To Dia G-tge or From To Slot <br /> ft ft in 'A'11I ft ft size _ <br /> 1 /Lit - <br /> } WELL SEAL - <br /> as iurtoce sinrtar} sed provide&I Yes V--l"N If yes, to depth —50 ft - <br /> %l er, �trtta selled %L, t 1lutian Yes No ,^, Irttercal It - t <br /> lfftth,d .f seabn Rork start 19 Completed_ 19 <br /> 101 WALTER LEVELS WELL DRIL 'S STkTE\FENT <br /> epth of first water if known._ ft This well w riled der my furt uvn and this r purr is true to the bcst of wry <br /> Standing level after well Urntpletion Ft knowledg0�11 <br /> be - � <br /> 1) WELL TESTS SIC-%%.E; <br /> L' well test tntdel ler E No It ' 0I ell Driller) <br /> � yes by whom <br /> pr of test Pnmp C Bailer ❑ Air lift ❑ <br /> vANfE <br /> D) nth to vlter it at trt of teat ft 4t end of test ft (Person firm or corporation) (Tvped or printed) <br /> ,,harge gal lour tfterAddrevs <br /> _._,-_,_�houn �L iter temprmhirn <br /> tical analysis made' Yes '❑ No i--T'If yea by whom Cit' ''] Zi <br /> War elactnr"c Ing m1de� Yes ❑ vn ses ttt'icfi enpv to thio reportLicense Nn � �SOS� Date of this repo <br /> the (REV 7 76, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />