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STATE OR CAUPORNIA - <br /> ORIGINAL THIS RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES 289675 <br /> WATER WELL DRILLERS REPORT No. <br /> kAce of Intent No. State Well Nes <br />,011 Permit No.or Date <br /> Other Well No OPT IS Q d.S <br /> (I) OWNER: Name Mnrrisnn Homes (12) WELL LOG: Total depth 295 ft. Completed depth- 288 ft. <br /> Addrems from ft. to ft Formation(Describe by color,character,size or material) <br />' City _ Plpasaft1< Hill . CanP - 3 To-Soil <br /> (2) LOCATION OF WELL (See instructions): 3 — 13 Qlay <br /> County _man J Q A Q u in Owner's Well Number 13 17 Sand <br /> Well address if' different+�From above d 7 — 20 Clay <br /> Township.�0,r S Range Section 20 — 21 Sand <br /> Distance from cities, roads,railroads, fences,etc. 21 27 C 1 d <br /> (3) TYPE OF WORK: 72 — <br /> New Well [N Deepening ❑ <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> ' Horizontal Well ❑ — <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) V}} <br /> (4) PROPOSED US 1 7Y- ,n \ 7 <br /> Domestic ^233 — <br /> Irrigation8 3 ! <br /> Industrial ❑ /�—.;•/� v\�``1 <br /> ' Test Well 1 ❑ ^� ��: <br /> Munici N © <br /> WELL LOCATION SKETCH <br /> (5) EQUIPMENT: f6 �G,yR�AVx<,kcK: <br /> Rotary ❑ 04 No U .Bizet /�' <br /> Reverse <br /> Cable ❑ Air ❑ \ et of bore 11 ^� <br /> Other ❑ Bucket'-.❑ from — <br /> / i ^` <br /> r—� <br /> (7) CASING INSTALLED: l \ 1 (8) PERP@RATIO S: — <br /> steel KI Plastic ❑ 6pnL4ere Type of pevFolatinn M'-"size of sCr�en <br /> From pp D' . Cage or is ✓�gS t — <br /> ft. fr, Wall eft • �t�� /ize — <br /> ffri 228 ��2,8. <br /> ' (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes (A No ❑ 1f yes to depth_ 4 t -ft- <br /> Were <br /> tWere strata sealed against pollution? Yes ❑ No ❑ Interval ft — <br /> Method of sealing .102 <br /> 1 Work starter! A 11 9L 19_$-. Completed—� 2 719_&9 <br /> ' (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known Ft <br /> This well was drilled under my jurisdiction and this rept is true to the <br /> undinglevelafterwellcompletion ft- lw.st of mriknntclydg� rind belief, <br /> ur t` ` _-- , k \ \ 1 <br /> ' (11) WELL TESTS: Signed _ <br /> Was well test made? Yes No ❑ If yes,by whom? H P n n (Welt t7riller) <br /> of test Pump E E Bailer ❑ Air lift NAME <br /> thall., <br /> to water at stag of test t. \t end of test ft (Person,firm,or corporation)(Typed or printed) <br /> AL A C H E C' Address - <br /> Discharge gal/min aFter urs Water temperature <br /> ZIP <br /> Cimmical atmiysis made? Yea ❑ No i3 If yes,by whum? City <br /> Was electric log made Yes ❑ No❑ If yea attach copy to this report License No. _ 2 9 fta-U--Daite of this report J A N 1 9E <br /> IP ADDITIONAL SPACE 1S NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 Sys <br /> ' DwR 1 aaa muv. 124144 <br />