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STATE OF CALIFORNIA <br /> ORIGINAL THE REZOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMEISIT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 312497 <br /> l Oof Intent No. c O;� tIp3F? +� state Well No. s <br /> cal Permit No.or Date,& Other Well <br /> (1) OWNER: NameA JDA (12) WELL. LOG. Total depth2-6j ft Completed dep ft. <br /> Address_ from ft. to ft. formation(Describe by color,character size or material) <br /> City d d Z1P <br /> (2) LOCATION OF W LL(See instructions): — <br /> Coanq� c Owner's Well Number "' <br /> Well address if differ"nt from above — <br /> Township ZI&AURange---29- Section fA 17 <br /> Distance from cities,roads,railroads,fences,etc fZ Ze O <br /> +� <br /> (3) TYPE OF WORK: ^ <br /> New Well1 Deepening ❑ <br /> Reconstruct:" ❑ — [I✓ <br /> Reconditioning C) <br /> \9 Horizontal Well © qn r, <br /> Destruction E) (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> `1r (4) PROPOSED US _ <br /> Domestic <br /> Irrigation T <br /> f Industrial ❑ <br /> "fest Weil � ❑ <br /> ( Munici ❑ _ d <br /> r)-dy 0 er [ <br /> WELL LOCA H be) — <br /> (5) EQUIPMENT: - GRA { CK: — <br /> Rotary Reverse 11No Si <br /> Cable ❑ Air ❑ c of bare — <br /> Other 13 Bu $n ked rom t — <br /> (7) CASINOINSTALLEI). (B) PE4APN-=P, <br /> steel [] Plastic a retTy oizeof Q — <br /> From ti.. Gage or 1 t <br /> Et. 11 ( i . Wall t. size <br /> (9) WELL SEAL: <br /> Was surface sanitarysealprovided? Yes No Cl If yes.to depth ft. <br /> Were stratasea[ed¢gaicutpoibutlonP Yes No 1 arvnl ft <br /> Method of sealing Work started— Ifl CompletedItJ <br /> (10) WATER LEVELS: <br /> +" WELL DRILLER'S STATEMENT: <br /> I)eplh of first vdaler,if known lF- <br /> � This weli wos drifted tender m jurisdiction qnd this report is trite to the <br /> Standing level after well completion _,,, IL best of my know ie eland w. <br /> (11) WELL TESTS: fjy� a[�— Signed <br /> Was avcll test made? Yes ❑ No� cif r) <br /> f test Pump A� Bailer ❑ Airlift NAMto vvatara start of test f Alendo#test A (Prs n,fition}(T d orprfnted)oil" <br /> g�gal/--:Haller hours Water temperature Addr V <br /> Chemical analysts made? Yes © No If yes;by whom? City 7.Tp <br /> 53 <br /> Was electric log made Yes ❑ No If yes,attach copy to this report License Nn. Date of this reart r <br /> OWR Ion(REV. 122aB) IFF A DiTIONAL SPACE IS NEEDED, USE NE%T CONSECUTIVELY NUMBERED F=ORM 86 9e393 <br /> 7 <br />