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a1sa7E32 <br /> ORIGINAL STATE OF CAWFORNIA Do not fiU>rn <br /> with DWit THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. .219693 <br /> ntent No. WATER WELL DRILLERS REPORT State Well Nn <br /> smut No. or Date Other Well No. zld�— //�__,,,_ <br /> OWNER: Nam 12WELL LOG: <br /> Total deptb,2A:ft. Depth of completed welL----ft. <br /> Add— frvvm ft. to ft. Formation (Describe by color, character. size or material) <br /> Zip L4 KAMAO <br /> —) LOCATION OF WELL (See instructions): _ 14 <br /> Counts' Owmer's Well Number <br /> I <br /> ll address if different from above — \,+ <br /> unship Ranke Sectio 32 <br /> 42 C4A(J <br /> Distance from cities, roads, milroads, fences, etc. , <br /> �. .� <br /> (3) TYPE OF WORK: <br /> New Well p Deepening ❑ — <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ M i VA Lk,1 <br /> Destruction ❑ (Describe \ — <br /> destruction materials and'': <br /> procedures in Item Ill <br /> (�0'rF- IM (4) PROPOSED USE: - <br /> Domestic ❑ - <br /> Irrigation <br /> . O � Industrial .,'� '. � ❑ <br /> Test Well ❑ <br /> Stock 0- <br /> Municipal �/��� ❑ — <br /> WELL LOCATION SKETCH Orlkf�T /r"�� <br /> EQUIPMENT: i8 RAVEL PACK: 7J — <br /> Rotary Reverse ❑ Yes.❑ No Si <br /> ble Q Air ❑ Diameter re <br /> her ❑ Bucket CO] c ed fmm to______ft. <br /> {7) CASING INSTALLED: _ (A) PERFORATIONS: — <br /> eE ❑ Plastic ❑ ConercNo, Type of perforation or sizeof screen — <br /> TO (, Dia. Ta ot. - <br /> ft Wall <br /> :surfZ <br /> as seal::�� yes, to ep h R. <br /> ere a No ❑ Interval h. <br /> Work started— <br /> Meth19 Comp I <br /> WATER LEVELS: WELL DRIL ER STATEMENT. <br /> J.;'th, of first water, if known ft This well was drdled u r my iurirdiction and this report is tnre to the best of my <br /> auding level after well completion— ft knowledge and h <br /> (Ii) WELL TESTS: SICNtD <br /> w•r ,�i ._+_e v— F- Nn M If ves. by whom? * h <br /> pe.nf test• •------ Pump Q Bailer ❑ Air lift ❑ :�A41 <br /> u water at start of test---ft. At end of lest -- ft — C rot. a r ed or p ted) <br /> pi gat/mut after hours Water temperature Address <br /> J analysis made? Yes L-1So C] If yes, by whom? City ' t' ' r j. • T` ZI <br /> a. <br /> electric ]nq made? Yes ❑ No Q If yes, attach copy to this report License No, ata of this repo <br /> DWR tae tetrv. 7-7111 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />