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ORIGINAL. STATE OF CALIFORNIA Do not fill in <br /> File with SWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No, 100059 <br /> 1" <br /> Notent No c,7G" 7' WATER WELL DRILLERS REPORT <br /> 0.t7 5t \�e„n or I]atc_ ——1 3z tYms c!1 4 <br /> Go2No�E/F ;� 01 <br /> lc Mn <br /> 1 1 ) OWNER Larne C�� - 4 f Gra.> tt�7�yj (1 ry) WELL LOG <br /> Tot ml drpt J ft Depth of coinp,cted ,ell-4t <br /> Address �T Prr>m ft to ft Formahun iDe,cnhe h, c-�rle,r char-icier }ve or m�ten1,l <br />(.t, dG �ii1►�r.�fp z,p O D 0 -C,/ <br /> �' C <br />( ?) LOCATIO OF WELL (SEt lnstnlctlotts) - /3 <br /> C aunt, 10Cl/ Owners 7l ell \umber <br /> 15 ell address If different from above — a� C/z, <br /> T,m nshrp A-71Y Ranke orE d C/7 <br /> Sechnn T r� <br /> l)xtance frnm cities roads railroads fences ett <br /> 460 <br /> ff 1 .f <br /> � <br /> �I <br /> I (3) TYPE OF WORK <br /> ll ell 'x Deepening f] QsLoe <br /> Re(onstructron �a �z <br /> Rccondrttomn6 ❑ <br /> HonzontaI Nell ❑ <br /> Destructmon E (Describe —/ <br /> destructrnn materials and p� <br /> procedures in Item 12) O>3 —,Vp o n �S�'ty7 Te <br /> X (4) PROPOSED USE =o o <br /> e%// Domestic I a5— _ O <br /> Industn tl ❑ fit <br /> olii Test 1A ell O r.r <br /> Stock 0 <br /> 'sfunlcspal ❑ <br /> WELL LOCATION SI,ETCH Other <br />?) EQLIPMENT (6} GRAVEL PACK -tq JBL _ .2 <br /> it-In [] Flrve rse ][I les}y Srz <br /> tiu' [] <br /> rhle ❑ Air GY 40 a //Tt <br /> [] Dsameter of bore <br /> Ther ElBucket Q Puked fTnm <br /> } CASING INSTALLED (b) -PERFORATIONS <br /> d r <br /> eel Plnstme 0 Concrete 10 T,pe of perforation or seze of screen <br /> From To Dia Gaga or Fromm\ �' To „Slt,� - <br /> ft ft(r in Wall ft\\\ ft `<slzE`� _ <br /> ,S- o.� <br /> cps ftr-�ro <br /> } <br /> WELL SEAL _ <br /> as surface sartitary seal provided" l esx \o �_ If ,es to depth �� a — <br /> ere strata sealed against pollutions les,& E Interval 07-4� It — <br /> thud of sealin C v r' \\ark st irted ly Cr,rnpleted I9 <br /> U) WATER LEVELS 17 ELL DRILLERS STATE\IE\T <br /> pth of first water if known.- Q it <br /> Thi vadmg level after well completm ft knnre edLr anddbe!of undo my Iunsdretmmr and thn re7urn n trice tr, the best of my <br /> 1) WELL TESTS <br /> is well test made? le N,, r' I f .es by hnn)' li Driller) <br /> Pe of test Pump Basler [] Arr lift [I <br /> p[h to uatcr at start of tes[�£t At end of test --,5— ft (Pennn him anilii <br /> rh p�OO C7 r7 mtran) (T-,.-4d p [ed} <br /> `^al/mmn after- 0„Y hoon \\-iter temperature Address <br /> al.sis made? les ❑ No C] 1£ ,e, hs uhom" CIO QG ...5 Zit> <br /> u< electnc log rnsmde;l Yes 9 No ❑ If ,es rttach cop, to this report License No ZQDate of this rept. <br /> rt <br /> v>Z 188 IF ADDITIONAL SPACE 1S NEEDED USE NEXT CONSECUTIVELY NUM$ERED FORM <br /> t <br />