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RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> lie with DWR DEPARTMENT OF WATER RESOURCES No. 060030 <br /> I Intent Vn_UU57 WATER WELL DRILLERS REPORT St tte Vvell No t <br /> einut No or D Lie Other well No�3 G C <br /> _1 r r 1 <br /> OWNER Nitne Dei Auch Con't Co. 12WELL LOC <br /> 1369 Li i � Tut t]deptli��ft Depth of completed well. ft <br /> re, n eo l n Blvd,, front ft to ft Form ition (Dexnhe b, chlor ch iricter ,ve or matenul) <br /> t, Trac Calif. Zip 95376 - <br /> LOCATION OF WELL (bee instructions) sandstone <br /> 11tirit,—SanO„ er s Nell Nun her <br /> ell iddres, if different From tbove and brown .sand <br /> Tmr inhip R inge Section 22 clay mix <br /> ,stone fruits Lilies souls rtilmad, fences etc r, _ o6kse sand <br /> 1111111 57 -- 76 l Z Pit>and dark gray cl a wi th <br /> two tricks of fine sandstone <br /> belt (I <br /> 7 (3) TYPE OF WORK <br /> New Well lX Deepening ❑ <br /> b PQAU r p c, Rertmstruchnn ❑ _ <br /> Reconditioning <br /> yl �� Horizontal Well ❑ <br /> 71 i Destruction ❑ (Describe `, ;__ — <br /> ��I�Q destruction m iterials amd — <br /> procedures in Item 12) <br /> (4) PROPOSED USES - <br /> `s Domestic <br /> Irrigation ❑ _ <br /> Indu,tnal ❑'73 _ <br /> r Test Well ❑ _ <br /> Stock [} <br /> Municipal [j — <br /> WELL LOCATION SKETCH Other ❑ <br /> (�J EQUIPMENT (g) GRAVEL PACK <br /> iter, A Reverse ❑ Yes M No ❑ Size ' <br />�ipea- <br /> hie L, Air © Diameter of bore 1.4it — <br /> Other ❑ Bucket �.,� Picked from An t e — <br /> CASIYGG INSTALLED (8) PERFORATIONS — <br /> el C] Plastic to Concrete ❑ Type of perforation or size nI screen — <br /> Fronl To Dia Gage or From To Slot - <br /> ft ft in Will ft ft s.ze - <br /> 57 tt 57 77 1,jT6X2jp - <br /> tWELL SEAL surface sanitary seal provided" les 1pl No ❑ If ves to depth . 0 It — <br /> '%ere strati sealed against pofluttnn" S es ❑ No k— Inter,tl It Iff,th-d of sealin^ 1�ork started 1 Cumpieted— 19 <br /> 10i '44ATER LEVELS Vv ELL DRILLERS ST4LTEME`T <br /> epth of first water if known_ ft Thts uefl u.ns drilled under nig trerisdrc and this report it rruc to the best or my <br /> St tnding level after Well cumpletit —ft knouled4c helref+ <br /> 1) WELL TESTS SIGNED <br /> „ill tut rutdr" Ses No [-j If yes h) „honO Canada ti'e!1 Driller) <br /> v i>r 4 te,t Pump [' Soler ❑ Air lift OX ` and p,,,,,, <br /> Dei)th to w iter it st trt of test ft At end of test ft k Person firm or corporation) (Tvped or printed) <br /> Fri art;c---g;9_A2_ al,min after t—hours «"ter temperature Address P-n- Rnx 990 _ <br /> A analysis m ides Yes ❑ No �} if yes, by tvhoni" C+ty 2tp 94509 <br /> W i, electnc lot. m tdO Yes ❑ No IF ,e, ittich cop, to thin report License Ne 342893 — nate of thin repo Nov. ( <br /> nae (REV 7 76 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />