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Do Not Fill In <br /> STATE OF CALIFORNIA <br /> ' oulmsa�awAL THE RESOURCES AGENCY 155278 <br /> 1se, th MR DEPARTMENTOF WATER RESOURCE'S No <br /> ,w <br /> ..C}W',- ,�NT1AL LOG WATER WELL DRILLERS REPORT' 'sr�WA NQ I <br /> etc.L' Gc7df] See. 1:5 7S2 Other Well No. 6-1 02 'W- <br /> 1 OWNER: (11) WELL LOG: <br /> Name Toni depth 0 it Depth of completed well 22-8 it <br /> Address Fogmanaae DesrrAr by color,ebaraeur,Alas of w4ierlel,and ssrrelrre <br /> xgul.tena C0 j-P 9-1 it to ft <br /> (2) LOCATION & WELL. <br /> County Owner s number of ray <br /> 10-1 Rancl <br /> Towath ,Raoxe and section <br /> land <br /> Distance from elan toads raalrmds etc <br /> S <br /> (3) TYPE OF WORK check) <br /> New Well 1) Dcepemwg [} Remndtnontag Destroying <br /> 78-82 Clay & nh la <br /> if tial.+itticrt,desa 07"atrrrai and 'ccrdrrs"'"am <br /> ' (4) PROPOSED USE (check): (5) EQUIPMENT.El Industrial ❑ Municipal ❑ Rotary <br /> Irrigation X1 Test Well❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> ' (6) CASING INSTALLED <br /> STEEEx OTHER If gravel packed _ <br /> SINGLE aouet.E <br /> ' Gage Dtarneter <br /> From10 or of From TO <br /> it Ft Daasn Wall Bore fc fc <br /> 95)1 –9,4 q T1111312- C1 RY– <br /> i <br /> Size aaf shat or well rine Stae of cn.eL <br /> Oarcrgbe ant <br /> (7) PERFORATIONS OR SCREEN. <br /> Ty0e of perforating or name of acreea r <br /> Pert Rows <br /> per <br /> p <br /> i From To per per Stzo <br /> ft it row it in x In <br /> ' II <br /> i <br /> CONSTRUCTION <br /> W4s a.urface asaanry teal rovidedl Y.0 -R-70 .hat depth ft <br /> Wan any rtrataaealad saaaaar olirAoa2 Yea[) Na Q If Yea Gore dapgb of.grata <br /> From ft to it _ <br /> From ft <br /> to Et pork snared 79 ,Cam steel 7f <br /> )lethod of mire WELL DRILLERS STATEMENT <br /> This well was drilled under.ray lurrsdaetrorr and this report if true tD the best <br /> I ' (9) WATER LEVELS' of my knowledgr and belnf <br /> Oe eh as vbub Watee was floe faegd if known It <br /> $hadsne Isrsf bafon pufonttaR tf known <br /> it NAME Hennings Bros• Drilling CO• Ina♦ <br /> persao,brmt or Corporation) (Typed or primed) <br /> $nadla level after aEorating rad developing ft <br /> (io) WELL TESTS Address 2500 W. Rumble Rd. <br /> ' Wu Aum.test made? Yea Mr No❑ if Yat by Wh4m� P-r.-& F, I M , St I calif-, 95352; <br /> ]d tial I. <br /> with fr drawdown after bis <br /> [SIGNED] <br /> (wall Drive) <br /> Tem ntrre of Water Wu a ekemieal anal tis made? Yea 0 No e1j <br /> ' S/as deetrm Ie mad,of veli) Yu❑ pia if Ye+ a"aeh w y L.Cenu N -Da[t�+ - ���� -, I9_C_.__ <br /> 'ts <br /> SKETCH LOCATIONS OF WELL,ON REVERSE SIDE � Gade Sea. 1752 <br /> ' DWRISOtasvaabl ,�>•asoxtrtr�oaw <br />