Laserfiche WebLink
F - <br /> , ,I r <br /> i <br /> ORIGINAL =~"' "` ` �r �f��'��J <br /> STATE OF CALIFORNIA _ Do not fill in <br /> THE RESOURCES AGENCY <br /> File w1f11 DV1/fj DEPARTMENT OF WATER RESOURCES No. 096881 <br /> Intent NO WATER WELL DRILLERS REPORT <br /> St Ate Well <br /> Yo <br /> L remit No or Date <br /> Other b%ell V,, Q G -t i <br /> ( 1) OWNER vam o c L (12) WELL LOG �6a <br /> ldoire.i Q III� LJ �� q <br /> Total Sept ft Depth of completed well. <br /> —eft <br /> l from: ft to ft FOrmatinn Describe h� whir character size it material) <br /> c ill G'iC1 �r Lip <br /> (3) LATIO OF WELL <br /> f inty (Sf�lrtatRlCtlO115} (] <br /> Q <br /> lOWIle*S Well Number C/ <br /> 'Xell addreye tf d+ffere above QaLJ <br /> Township K r� , <br /> R nye—__ Secho — /fQ <br /> D,.,tun.a frim a.ities roads railroads nc s etc <br /> 5. <br /> 6 <br /> � b - <br /> S (3) TYPE OF W ORx <br /> New Well pQ DeepeningLO <br /> ❑ <br /> � Reconstruction © <br /> �. Reconditioning ❑ <br /> Horizontal W ell 01CL <br /> Destruction 0 (Describe (�� > <br /> destruction materials and ', [1 <br /> % M e procedures in Item IX}, J _ <br /> errLk <br /> S (4) PROP09ED USE <br /> Omest]c <br /> otL/ <br /> i <br /> i L rngahon ❑ -,)0 <br /> � � J <br /> oCIt Q Industrial \ ❑ �' <br /> Test Well Q <br /> X22 e Stock <br /> 9 unicipal' a <br /> WELL LOCA ION SKETCH Other ❑ <br /> (5) EQUIPMENT (6) GRAVEL PACK f p <br /> Rotary Reverse <br /> f] Yes 7"''' No ❑ Size � ... <br /> C ible ❑ Air ❑ Diameter of bore — <br /> Other ❑ Bucket [I Packed frtim�a s94 _ <br /> i7i CASING INSTALLED (8} PERFORATIONS <br /> Meel Plastic 0 Coucreta D Tvpe of perforation or-size of screen _ <br /> From To - Dia G tb\r Fr,0tV To (� Stot J - <br /> ft ft , ` in Wall fh� ft `. Size/ _ <br /> 0 2 0 ' ' - <br /> '9) WELL SEAL <br /> %r as surface aaisitary sell provided 1"'M No u if yea to depth,57 6Et — <br /> Were strata sealed ng a st pO11 hnna Yes ❑ No ❑ Interval—_--ft _ <br /> �tcthad of sea Ln ry` «'rink star[ I d / <br /> Complet 19 � <br /> (1D) W4TER LEVELS WE L RILLER'S S ATEMENT <br /> Depth of first water if know f# I h:a !! 4 rtlled under mar esdi sr,ben <br /> Stinding level after well cnmpletio _ _—ft t.nou,! a and else/ :Le ,r, 7 1 <br /> to rfn n <br /> (€1) WELL TESTS NED <br /> `N is %ell test madea Yes G No If Yes by whom' (W n er <br /> Tape of teat Pump ❑ Bailer air lift ❑ <br /> NAME /� <br /> De h to water at start of test ft At end of test h ( Bison firm or to <br /> Fr Bal;min aHer_ hours til ater tem natu -kddres S t< e <br /> pe re �L^ • � <br /> w il analysu made Yes ❑ No�n If .es by whom? City Q/T�llrtz.�0I --���— <br /> «as electric lot; made- Yes ❑ No CK It ves attach cnpv to this report License No_3� a O-rl nate of this repo ZZ �� <br /> DWR 138 ("ry 7 79, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />