Laserfiche WebLink
rr �• <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Pill Is <br /> file with DWR OG (51.ttle"7079,7090,7091,7082,V4"*C.d.) O " <br /> t'50 THE RESOURCES AGENCY OF CALIFORNIA �' �5 2 - <br /> • �p?3 �be Sea' DEPARTMENT OF WATER RESOURCES State well No Z-7 P <br /> VALI �x VV Other Well No. <br /> (I) OWNER (1.1) WELL LOG: r , <br /> Name :a AA Total depth fr Depth of completed well1.14 fr <br /> Address Formation Drrrribe by cofor character ruse of asdiensf said strreeane <br /> ft to it <br /> (2) LCATION OF LL <br /> Countyf4. Owners number if aay <br /> Ternship Range end Sec � <br /> Distance from carers roads railroads etc <br /> (3) TYPE OF WORK (check)- <br /> New Well X Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destruction,describe material and JZocedure in Item 11 _ <br /> (4) PROPOSED USE (check) (f) EQUIPMENT. d - <br /> Domestic CK Industrial ❑ MunicipaI ❑ Rotary ❑ .� - .� <br /> Irngation Test WeU ❑ Other ❑ Cable (� <br /> Other ❑ 17 <br /> (6) CASING INSTALLED- <br /> STEEL OTHER If gravel packed <br /> SINGLE 0 DOUBLE <br /> Gage Diameter <br /> From To or of From To <br /> it it Diam Will Sore fr— it <br /> it <br /> Size of shoe or well rsng x Size of travel <br /> Describe joint <br /> (7) PERFORATIONS OR SCREEN• <br /> I ype of perforation or name of screen <br /> Perf Rows <br /> From To per per Size <br /> ft <br /> it row f* In x in <br /> r <br /> (8) CONSTRUCTION <br /> Wu s surface amcary seal provided? Yes ❑ No To.hat depth fr <br /> r✓ <br /> Were any+[tau+esled against pollutions Yes No❑ If vas note depth of ttracs a <br /> From fr co it <br /> From fr to it Work started - 57 " 41 Completed 19 6.1 <br /> Hethod of walla e—Vi9tL.# 14 WELL DRILLERS STATEMENT <br /> (9) WATER LEVELS This well was drilled under my jurisdiction and this report is true to the best <br /> of my knowledge and belie` <br /> Depth at rltich wiser wsa 5rsc found iE known ft <br /> 5canding level before pertorattng tf known ft NANIE r <br /> (Person firm or corporanoo) Iry dor printed) <br /> Standing level after oerforitmlt and develo in ft <br /> (i 0) WELL TESTS Address <br /> 6o..Pt,q1..J0 Yes Q No ❑ If yes by whom? <br /> i <br /> ad sal linin wah fr drawdown after hn [SIGNED] <br /> /fir!!Drill ) Jia+ r- <br /> Temperature of water Was a<btmtesl+nslnas made? Yes ['] Pio [] / <br /> mat electric Iot made of well? Yes ❑ No [] If yes attach copy License NoA �-71 mated <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR I ea tAEV i 671 96391 950 10 GS 90M YRIr O D osr <br />