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)RIGINAL STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY Do not fill in <br /> ile with DWR DEPARTMENT OF WATER RESOURCES No. 100059 <br /> 1 <br /> ;,.nit <br /> ��JJ,.tent Na, �0WATER WELL DRILLERS REPORT �ts�tltayrte� �t el] >vr.No. of Darc i�4 Well No�2NOGE/f7 <br /> I <br /> I) OWNER: rrz e,.r>s1i (12) WELL LOG: <br /> Total depth-9,It'ft. Depth of completed welLf_—Vo It, j <br /> ddress eY,r~A from ft. to ft. Formation (Describe by (%dor, character, size rrr material) Il <br /> Zip <br /> 21 LOCATION O WELL (See instructions); <br /> :nuntY Qrr:.�/J)s' puner's Well Number - <br /> fell address if different from aboveIW - L. <br /> r,wnship_ __ � Range Section - b �.+� <br />, KP iQ <br /> rktance from cities, ruads, railroads,ffenc-a es, etc f a7s - �� <br /> .L 07e - Y3 :Sa., <br /> r <br /> ." / <br /> N (3) TYPE OF WORK: os <br /> Neu-1{ l4` <br /> e!I�/ Deepening ❑!" <br /> f� y <br /> Reconstruction <br /> Reconditioning ❑ _ i <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and <br />€f procedures in Item 12)' 5,3 -p'[I p _T-/67 Te <br /> �/ <br /> /� (4) PROPOSED USE: <br /> L"evII Domestic '.Q/. �• _ � -: <br /> Irrigation <br /> Industrial ❑ <br /> Test Well ❑ <br /> Stock ❑ - . <br /> Municipal ' ❑.. - - " <br /> WELL LOCATION SKETCH 7 Ihher <br /> i) EQUIPMENT: (6) GRAVEL PACK: '` `� �'•.,. .7�(1 _ <br /> ❑tsn ❑ Reverse les No ❑ Siza/ a ,0 C fT <br /> able , Q - Air ❑ I]itimeter of bore C> <br /> ther <br /> [] Bucket ❑ Packer-frum._..__Q�_to��f� - p �' <br /> CASING INSTALI ED:;+-,, (8)`PERFORATIONS: <br /> eeIJK Plastic ❑ Co •'rete'a. Type of perforation or size of screen <br /> i <br />�. From To Dia. Ga e"r To <br /> ft. ft. in. Wali ft y pft. <br /> Q• �� 4 � �� t7J .mow i /�r ! <br /> 1) WELL SEAL: - <br /> as surface sanitary sea] provided? YesX No 0 If yes, to depth ft. - <br /> ere strata sealed against pollution? Yes,{ No ❑ Interval ft. - <br /> zthod of scaling O Ce 7-- Work started u 19 Complet I9 <br /> Q) WATER LEVELS: WELL DRILLER-S STATEMENT; <br /> ttrth of first water, if know � _... "- ft. This well mas drilled under m b <br /> knnrcled 4 iu riedicf inn anr! this ,elm rf is tore to the best rrj my <br /> .carding level after well completion- ft. �r and belie/. . <br /> 1) WELL TESTS: tsfllY.lc j %� 51C\'LU <br /> As well test made? les No, I` If ves- M= whom:+ [s 11 Driller) <br /> PC of test Pump Bailer ❑ Air .lift ❑ - <br /> -pth to water at start of teat o i\A7,91 t � r ) 1 <br /> �_ft. AI end of test - ft Person, firm cngsrrration) (T (or r fed <br /> "L` ~ <br /> 07010S.1/rain after -hours W.1ter temperature Address d�' Ae•e r <br /> f Trade??ade? Yes ❑ No ❑ If �"es, hy' whom? Citi' QG S - ziy <br /> � /Otj.7 r <br /> as electric log "m4e? Yes No [J If es. attach copy to this report License Nu" Date of this repo <br /> NR IBB (tt[v. 7:71s) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> Y <br />