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ORIGINAL , STATE OF CALIFORNIA <br /> Do not fill in <br /> ' THE RESOURCE'S AGENCY n� <br /> �!!e with lyWR DEPARTMENT OF WATER' RESOURCES NQ, 206208 <br /> � <br /> Nf Intent No, WAFER WELL DR[LLERS REPORT t <br /> iStale Well No <br /> L rmit No.or Dato Q <br /> Other Well No.. <br /> (11) OWNER: N ation (12) WELL LOG: Tall depth 11.4,ft.Depth of cod, feted wo 1-12 <br /> ler p Jt. <br /> xom to- ft. Formation scribe by color, character, size or material) <br /> city Ri on CA <br /> (2) LOCATION OF WELL (See Instructions): <br /> County Owners Well Number M-10A See Attac ed <br /> Well address if dtfforant from above <br /> Tatynship 2 _--�RanKe 7� Sectio �G fie/ <br /> Distance from cities,roads,railroads,foam,etc, k+ <br /> 'd <br /> i <br /> (3) TYPE OF WORK, F <br /> New Well fg Deepening ❑ =A <br /> See Attached Map Reconstruction ❑ _ <br /> Reconditioning 0 k � <br /> horizontal Well ❑ <br /> Destruetlon ❑ (Describe - <br /> destruction materfals <br /> Procedures In Itemlq$ - t %. Y } <br /> (4) PROPOSED LJ - 4 <br /> Domestic _ <br /> Irrigation ��'., ❑ \. > i <br /> "a,4> <br /> Industrial ❑ }- <br /> TWell E3�', <br /> L 1 <br /> Municip <br /> WELL LOCATION SKETCHY Other MO�{3t0 , _ �^ V <br /> (5)'EQUI[PUENT: (6) GRAY CK, <br /> Rotary ❑ Reverse ❑ , , f No I.1 Size <br /> 13` <br /> Cable- l7 Air t�ter of borc 9 - <br /> `�' 87 13 4 <br /> Other 0 Bucket ❑ eked f m <br /> (7) CASING 1NSTALLEI7t (9)',ERFORA fibtm - <br /> Steel❑ Plastict',ort£?Cies C1, Type of p � one of screerk4 1 -, <br /> From• To ,Dfa. C.-dr R � � To <br /> ft. ft din. Wall <br /> 2 ,_[t= Sch 40 92 '� 112, 10 <br /> E <br /> �: <br /> (E3) WELL SEALt <br /> Was surface sanitary seal provided? Yes I( No CI 1f yes,to deptt, 15 h. } <br /> Ware strata sealed against pollution? Yes IN No ❑ Interval 15-$7 ;t: - <br /> Method of sea, Work start i8 ComplCt 19 <br /> (10) WATER L NMSd WELL DRILLER'S STATEMENT: <br /> Depth of first water, if kno This roeu was drilled under m <br /> Standing level after well cornpletio knowledge and belie/ !.Jurisdiction and this report & trate to the best of mU <br /> (II) WELL TESTS: Stcn�n <br /> Was well test made? Yes ❑ No[ If yes, by whom? (Well Drllle <br /> Type of test Pump E3 Bailer❑ Air lift C] NAME LAYNE WESTERN CO. INC. <br /> Depth to water at start of teff !t At and of costit P B on} (Typed or printed) <br /> f/mid after- a Add <br /> 16 0 i trek ail brplrf. <br /> a..._�..Sa ours Water tempera <br /> --1 1 analysis made? Yes 1x No❑ If yes, by whom? Canonie T., City -- Fontana, CA, 7th, 92335 <br /> ? Yes❑ No [f If yes,attach Copy to this report License No..452609 Antra of this report- _9/9/88 <br /> h <br /> �1 IF ADDITIONAL SPACES IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i �( <br />