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Nov 8 I9jj
<br /> ORIGINAL WATER WELL DRILLERS REPOrr Do Not Fill In
<br /> File with DWR (sections 7079,7080,7011,You,Water cede) NO
<br /> THE RESOURCES AGENCY OF CALIFORNIA 0 44205
<br /> _\ /St a ,11 No?I] I�r.- I'?C4-
<br /> DEPARTMENT OF WATER RESOURCES �r— ++
<br /> J`�J Other Well No �� C
<br /> (1) OWNER: (11) WELL LOG:
<br /> Name 1f/teal-11T.,.I sloth rt. D.Pth at,omPltaa au SZ n.
<br /> Address -1 /S / 9—. sloth— F.rm.tle.: Dr,nbr Is 1.1u.,rb...crrr,,ler./..$trial,and,rr.rt.rr
<br /> 3 ft.to ft.
<br /> (2) TIO OF LL:
<br /> Ca.." o.ntrr...be'.if.., S
<br /> T.. S' 1
<br /> a Duu.ct from ritimroods,reilro.d...m. 'Z
<br /> qg-
<br /> (3) TYPE OF WORK (check):
<br /> New Well ® Deepening ❑ Reconditioning ❑ Destroying ❑
<br /> I/destruction,describe mafai.l and procedure in Item 11. 1 a
<br /> (4) PROPOSED USE (check): (5) EQUIPMENT: -
<br /> �. Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑
<br /> Irrigation ® Test Well ❑ Other ❑ Cable M
<br /> Other ❑
<br /> .� (6) CASING INSTALLED:
<br /> ETES OTHER: If gravel packed
<br /> SINGLE DOUBLE
<br /> Gage Diameter
<br /> From To or of From To
<br /> ft. ft. Di.m. Wall Bore ft. ft.
<br /> D de
<br /> FM WFr
<br /> yal 1141!
<br /> Sias of shx or rel dna: )[ { Site of er.vd:
<br /> Drcribt joint d e iI
<br /> (7) PERFORATIONS OR SCREEN:
<br /> Tian of Wf.n,i.n or.amt or arm.
<br /> Pert. Rows Watwr
<br /> From To per per Size O 8 �2Cs TU✓Q
<br /> ft. ft. row ft. in,x in.
<br /> — (s) CONSTRUCTION:
<br /> aru.,art...tee i,.,,.1 Prodded? Yes ❑ No To.h.,dt,,h ft.
<br /> Parc.nY nnu ruled q.im,pollwioni
<br /> Yt, 51 Ne❑ If Yer,nate depth of,tr.,.
<br /> From f,.m /() C ft.
<br /> From ft.to ft Werb tear,.$ • 9 ,CemPlerd -/ t9
<br /> Meth..$of mate. V L 1 1 WELL DRILLER'S STATEMENT:
<br /> 9 WATER LEVELS: This writ we+ drilled vada my i.,i+dielion and this report n true to the best
<br /> ( ) of my knowledge and belie).
<br /> ur,nh as �hltb79
<br /> •.r 6 . found, if b.o�n 4.
<br /> s,..d;. Irt.l btfort der.<:n , if b..— ft. NAME VALLEY WATER WEL Drn
<br /> smvdla Lt.l .1,., rf...ti. ..d de.el. iv ft, (Peron,brm,.r e.rponrien) (rY7td or Pri•np
<br /> (10) WELL TESTS: Address
<br /> m.aA Yn tij No ❑ If Ym,by vbeml CQ O
<br /> .A./min.wish it.dnndow.due [S6NED]
<br /> (ares Denser) hen pry
<br /> Tapenm.of ve.r Wu.eheminl seal .i.made} Yr (] No ❑ ' � �`� ro
<br /> V.,.lwtri,to es.d.of stili Yr [3 Na ❑ If lm,sttech taps License No.� Mated 19_
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR less :Rev. R-65) ...n-uo:o.n wv Yno :O A o0
<br />
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