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1 � I <br /> 77 � <br /> ORIGINAL STATE OF CALIFORNIA .l Do not Edi 1n <br /> File with DWR THE RESOURCES AGE=NCY <br /> � <br /> CDEPARTMENT OF WATER RESOURCES No. 083764 <br /> a of lotant No, 75365 WATER WELL DRILLERS REPORT <br /> 79-1205 <br /> Siete Well No. <br /> + <br /> ' Permit No. or Data Other well No.a �".� G <br /> u <br /> Richard Van Boven <br /> 2370inca..1 :t LOG eDffZ±Q3:ft. veplri at completed w t, t <br /> Adds <br /> aI1e a r a from ft. to ft. Formation (Describe by color, character, size or material) <br /> City <br /> ZIp <br /> 29 03:a <br /> 2 �i <br /> LOOotsLL ( - <br /> Seo instnrctlons): <br /> County Osv—es Well Number a <br /> Well acUlress if�]itfrA nt from above – <br /> Taivnshl L 'J _ <br /> D hang SIV. <br /> t tgo from cities,roads,railroads,fences,etc ' a geo V t <br /> n'�1rlpon <br />` l rL 1 (3) TYPE OFVVORKt <br /> New weft 9 Deepening L1 <br /> ' 1 Reeonstntctian ❑ <br /> Reconditioning ❑ r_Opar we r was a O <br /> phly <br /> Horizontal Well ❑ �Ne p <br /> Destitution ❑ (Describe a er rem Mng or Tne seal <br /> delft c iOA mntcrfnIs <br /> procedures In Item d� g r <br /> t ! (4) PROPOSED _ <br /> l. Domestic <br /> Irrigation _ <br /> Industrial ❑ j <br /> O _ <br /> T Well ❑ <br /> ir2 Munici <br /> I <br /> WELL LOCATIOV SFWCFI Other ❑ – <br /> (5) EQUIPMENTt (6) GRA PACK: <br /> Notary ('X Reverse ❑ ] No Siv. <br /> Cable ❑ - Air ❑ ter of bore <br /> I <br /> Other ❑ Bucket 0 -103 <br /> ty � <br /> (T) CASING INSTAI.L,Cs"(�. (B1 1SaaFOIt Ut <br /> Steel [) Plastic[ Typo nF pe r ' n or iizo of scree <br /> M <br /> NZ <br /> From To Dia, <br /> g r F o To <br /> ft. ft >in, Wali ft. siy <br /> X _ � <br /> (9) WELL SEAL: ���(� - <br /> Was surface sanitary seal provided? Yos [f No ❑ If yes, to depth 50 ft. <br /> Were :strata sealed against pollution? Yes ❑ No LF Interval _rt, – � n� i <br /> Method of sea cement Work started 16pacte <br /> Comd 79 <br /> (10) 'NATER LEVELS: WELL DRILLER'S STATEMENT: <br /> E Depth of 9rst water, if kno <br /> %vn This soeff ttws driller! under my jurisdiction and this ort tr true to the best of my <br /> Standing level atter well camplotla ft. knowredg.aail'6' <br /> (11) WELL TESTS- SiaNED l <br /> Was well test made? Yes D N.Ra If yes. by whom? ``' ea nril�f <br /> Type of test : Pump 0 Baiter❑ Air lift p NAME Tanero lWfe1.L �rl ming% C a s <br /> Depth to water at start of tear ft At end of test ft _ u, oo gti 1 ed r rind ! <br /> �— aaarps J' :1-31Irr:' Oletx B l��sii ) <br /> I' BrSt -_ nlfmin a#ter-- - -- 1+otus Water tempera d da 8 t a 3 <br /> asW1 analysis made? Yes❑ No 0 U yes, by whom? aty s Z§Zr1p <br /> W1 <br /> !og made? Yes [J No© IF yes,aKach copy to this report License No 1. ate of this report - 11 17 <br /> ,OWR Jag InEv.yrra) 1F ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />- q <br /> �h <br />