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File with DWR DEPARTMENT OF WATER RESOURCES NO. 3 b 19 4
<br /> Wl its 4 hitcnt No WATER WELL DRILLERS REPORT ittte N%ell \o
<br /> nett Nov or Dale Other hill \o �_�
<br /> .I
<br /> L)WNER tmrR$ ( l2) WELL LOG Tottl de.ptb-1-6Qft Depth of completed well 1 60ft
<br /> 1[rc,Y-4Q era Rd- from Ft to ft Fenn Ltion fDt,tr,be hs u+lor ch irrlter rite nr ni sten fl)
<br /> 20 '
<br /> Lip
<br /> LOCATION OF WELL (tit r ui,t!uctmn,) _
<br /> niit♦ Ih,ner} wLll yumher33
<br /> li 11 ,ddrths ,t different hr ,it th,,v, 8 sand,
<br /> „stili, Rini,i, p8 - 8 sand &- clay 1i,t nice trt„ii title, ro ids rule,id% fence, etc 8 — 101 sand
<br /> — _— 101 - 111 clay
<br /> 111 - 116 sand
<br /> 116 - 119 sand & clay
<br /> (3) TYPE OF WORK 119 136 clams blue
<br /> \ew well X Deepeninu ❑ 136 - 139 sand & clay layers
<br /> Reconstruction ❑ -
<br /> Recnnditioning ❑ -
<br /> Horizontal Well (] -
<br /> Destruction ❑ (Describe -
<br /> destructuon materials and
<br /> procedures in Item 12) -
<br /> (4) PROPOSED USE —
<br /> Domestic M -
<br /> Irrift ition ❑ -
<br /> Indu,tri 11 ❑ -
<br /> Test %4 ell ❑ -
<br /> Stock ❑ -
<br /> Munictpql ❑ -
<br /> iN rLL LOCATION SKETCH Other ❑ -
<br /> i)
<br /> EQ NT (6) GRAVEL PACK -
<br /> r, Reverse ❑ Yes$) \o ❑ S17 Pea. -
<br /> i le ❑ Air (:1 Diameter of bore -
<br /> `thtr ❑ Bucket Q Picked
<br /> CASING INSTALLED (8) PERFORATIONS -
<br /> 5tce, M PI latLL ❑ Contrete 7- T,pe „f perforation or size of screen
<br /> From To Dta Gage or From To Slot —
<br /> ft it in Wall ft ft size —
<br /> tf 12 119 l60-----Y5-11
<br /> 9) WELL SEAL Bottom ft. of casing 3.s ug.
<br /> \619 sort ice seinitary seal provided' Yes X No ❑ If ves to depth ft
<br /> tl
<br /> C3E]ere strati sealed Lgainst pollution" Yes No Interval ft
<br /> ethod of sealiri� l\ork started 19C,nripleterl l9
<br /> 101 tii kTER LEI,ELSNL ELL DRILLERS ST aTE i JE-NT
<br /> Depth of first water if known 4`r^ It This well was drilled tinder inu iurlvdteton and thti report is true to tht befit nt mo
<br /> tmilmt le,el titer „ell toniplcts,ni 44 ft knnuledge and heluf
<br /> 11} V,ELL TES'T'S Su,\ED
<br /> \V n RFi1 te,t n ides l es X \,o C ,e
<br /> !t s h, Whom' («ell Driller
<br /> T,, 4 test Pump _7 Biller ❑ Air hFt 1M `-ME Wal ter—Q. 1 0.
<br /> tD-lyth t„ i,Iter it tlrt of test-it at end of test—ft (Person form or corporation) 1T,ped or panted)
<br /> U„c h true� hours w iter temperature
<br /> Add re's -P _ l'1 r'� QQA
<br /> .,it nun •fitter� y--�-�-+��g��V- ---• �t
<br /> r' +I inil,,ts enadeJ Yes No ,X If ,r, b, whams Ciry 16 I�(]rkton� aI I eoxnl [7—Zip- `r9 G01
<br /> F7 LnL fu¢ made" It, ❑ \u 3 If tea ittiLh Lup, [» dila report License No. Date of this repo
<br /> 189 prr 7 ie IF ADDITIONAL SPACE 15 NEEOED USE NEXT CONSECUTIVELY NUMBERED FORM ..01. 15,7 -soM .7UA.71'T oar
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