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fRIGINAL. STATE OF CALIFORNIA Do not fill to <br /> e with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES NO. 060054 <br /> F lnttnt Nn / F�'S' 3 WATER WELL DRILLERS REPORT <br /> State Well No <br /> ['crrnat No or Dtte <br /> Other Well No <br /> POWNE „r, +� 12 WELL LOG /', <br /> / Total deptt�ft Depth of completed we1�Ft <br /> R <br /> ss 4 7 frrrrn ft to ft Formation (DescnbebV color charieter stzt tar material) <br /> Gp <br /> (3) LqC AT OF WEX,L (Ste utetttictlialti) ��� <br /> ,at Ow <br /> all tddrrw if d Brent n above <br /> FimnN rue Sectio <br /> rstaoce form cities [olds 1drouls fence, etc <br /> _ c <br /> (3) TYPE OF {WORK rf <br /> New Well,,lDeepenini, ❑ %' \ <br /> Reconstruction ❑ _ <br /> Recondetiomng ❑ <br /> Horizontal Well ❑ ` — �'1 <br /> Destruction [7 (Describe 4 - <br /> destructu)n materials and <br /> procedures its Item 1Z) — — <br /> (4) PROPOSED USE- <br /> Domestic A< _ <br /> Irrigation ❑ _ <br /> Industrial ❑ _ <br /> Test Well ❑ _ <br /> Stock n <br /> Munutpal ❑ — <br /> �VELL LOCATION SKETCH Other ❑ — <br /> ( EQLIP%IENT (6) GRAVEL PACK — <br /> /v!j <br /> ttan e Reverie ❑ Yes 2" No 0 Sate <br /> able ❑ Aar ❑ Diameter of bore — <br /> Other ❑ Bucket ❑ Packed frrtm------'5to - <br /> -i CASING INSTALLED (8) PERFORA77ONS — <br /> eel ❑ Plastic 9?'/ Concrete ❑ Type of perforation or size of screen — <br /> 111110 <br /> Froin To Dia Cage or From To Slot <br /> ft ft in VvaII ft ft S ze <br />�) WELL SEAL <br /> as surface unitary seal provided' 1es No [j If yes, to depth V"` ft <br /> Were strata sealed a¢a t polls ria j,es Vo ��rval ft — <br /> ethod of seaLn r �► r Work started I9 Cnmplet 1 <br /> 0) WkTER LEVELS «ELL DRILLERS ST-kTENIEVT <br /> epth of first water of known R This [Lett tt,us drilled under r t rrsdrett rid this tart rr trite In the bert nt my <br /> Stan&&., level after well completmn it knouledAv lie/ <br /> 11) WELL TESTS Si"-,.Ln <br /> rc «rU to%t made° Yes No ❑ if aes ba whom ( Dr ri <br /> lar F test Pump ❑ B tiler ❑ Aer left j '�T 4NI _S l✓�L` <br /> Depth to w iter at start of test it At end of test it [jun fimt /Oration t Ta ped or printed} <br /> V"e'lrectrac <br /> 9-5- g-1/men after/hours Water temperatureat an alysts made Yes ❑ Nu f is b% whom City 0 log niadel Yes C3 Vo If ,es attach copy to this report •License N+ Date of this repo Q <br /> lae (REV > 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMSEREO FORM <br />