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l y <br /> STATZ OF CALIFORNIA Do Not Fill In ' <br /> i <br /> �., THE RESOURCES 4GENCY <br /> Y ' CRIGINAL I DEPARTMENT OF WATER RESOURCES awlt J•\a 57188, <br /> pf�Bwl��� WATER WELL DRILLERS REPORT` Stale Well:Io. <br /> Other Wall NoQa-089 <br /> Y <br /> j <br />{ _ Name", _C?_rlF BQ 'p.�C'�17 14o Total depth N. De th of eompined weld 140 'ft, � <br /> Address Y' 4f�7 Int Fmrnreion: Denrrebe by wive,cbdrerlrr,liu of malrrkt,end somaum <br /> _ ft.to <br /> (2) LOCATION OF WELL: {Q .. )2 p�and <br /> Coancya J0,1C� f.t. �7Ow"Wt number.if any I`2 .r+ 2 brown clay <br /> Townebi ,Ranae,and Section T-2.-x15 R+-,8-+E 900. 20 2g ..t 32 sand r <br /> 1. T7isuace Elam eider,[oath,nikoadr.ete. ETi1f,Z1 9:Lde OI .Jl ao 46 bard GIE%r � <br /> u t 1!29 Of Il rah 0 .4 2 sand <br /> 1 ;. <br /> f (3) TYPE OF WORK (check): 7 2 r bmvin clay <br /> New Well M Deepening 0 Reconditioning j] Destroying 0 6 .4 9 q nd r <br /> Ifdntraelfon,deseribernnlerialmld procedure lnItem 11. 9 r..t 102 sand & Y•c1VAZ <br /> (h) PROPOSED USE (check): 1 (f) EQUIPMENT: 02 — 104 Cie <br /> Domestic ❑ Industrial 0 Municipal 0 Rotary r ❑ 10 — 0$ sand F <br />` Irrigation FL] 'fest Well❑ Other ❑ Cable � 10€3 •+ M sand & gravel � <br /> Other 0 112 <br /> (6) CASING INSTALLED: 114 124 brown, <br /> olay <br /> STEEL- OTHER. If gravel packed Grti4 . 1 2 brittle Clay <br /> SINC.LL-10 oouaLE 132 140 brown clay <br /> i - Gage 17iame[cr <br /> wj sand <br /> From; To or of Front To <br /> ft, ft. Dian. Wal! Bore <br /> 0 1 2C 12 10 <br /> r pp <br /> Siec of shot at veil Ain 2lixr a V Sixe of curet: k <br /> ' <br /> Daaceibe io:nr But,'tweld - <br /> (7) .PERFORATIONS OR SCREEN: <br /> 7 of perfora[ion or name of scrap <br /> Perf. Rows ir <br /> From To per per Size <br /> it. ft. row ft. ut.x in. <br /> t <br /> } <br /> 1 <br /> ! <br /> (6) CONSTRUCTION: <br /> rVas a swrfaer naltary red provided? Yes f] No❑ To what depch <br /> Were MY Musa sealed asaiasr ollotioa? Yes 0 No f3 If ye,,note dcptb of stria <br /> From ft.to fe. <br />- From It,to ft. Work started re 19 r Coanpla[ed 14 72 f <br /> Mcthad of 104'six WELL DRULER'S STATEMENT: � <br /> (9) WATER LEVELS: This weft was drilled under my jurisdiction and this reparl it true to the best } <br /> ' Uepth ac which waceA ear$tat lovnd,:f Itnown 9— of ony kerowledgr and belief.ft. R <br /> St-428 level before pt,focttiax. If known fr. NAME~ 7 <br /> Suadjap Iry-]after erforacioF and dcvela iv ft, fFCfiOn,Euro,ox earparateon) (Typed or prated) I <br /> (10) WELL TESTS: Addreu Iran Allen <br /> - a umD tae made? Yea❑ No 0 tf Yes,by whom? q <br /> t ds �ai.fr[sin.wi[[e fr.drawdown after bts. [SIGFyEp r t <br /> j�7�J Temptnsnre oI rater Was a chemical anal iia made? Yea E'J No tWrtF Arlt rrj <br /> Crar cleenic to made of*,41? Yes N9 Cl if yee,atraeh copy License No.--i_ L�ate ~1 4 —,t72 <br /> .SKETCH f.00ATION OF WELL ON RF61ERSE SERE <br /> 's <br /> DWR IBB (REV.9-eat 261MD109.66 SOFA yRIPAD OSP <br /> J <br />