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1 x•+av�lVA� SPATE OF CAt.1FORNlA OO 7�Ot fill 61 } <br /> ? THE RESOURCES AGENCY Do <br /> i <br /> File with DWR DEPARTMETIY OF WATER RESOURCES l No. 36 13 9 <br /> WATER WELL", DRML � <br /> N+"tire�,f Intent;Iu. ERS REPORT <br /> ,,real Ircrrnit No.or LPmc Other WC11 <br /> r jWNE-1t: .11\„me (12) WELL LOG: Total deed ZOaft. Depth of completed rvciL.LZ&fl. <br /> Addrex fmnt ft. to R. FOrrnatian (Describe by calor, character, .rile nr Mr(t:Qri tl) <br /> FI <br /> City lir - <br /> (2) LOCATION OF WELL (See instructions): 1 <br /> County Oa�ter's tt"all Number - 48F, <br /> Well addre. if diffuent from above 48 - 70 clay <br /> T..rvtyshev Rance tttin 70 80 nand 1 <br /> Distanty frim" cities, roads.rallw.nds,fate,e:,etc. 80 - 92 ala <br /> 92 - 100 sand F <br /> 100 - 06 clay <br /> it <br /> 1.06 - 117— grave <br /> f (3) TYPEOF wORK: - Clay <br /> M ! <br /> New Walt � Deepening ❑ - grave <br /> Iicenrtttrvetinn O - a. ay <br /> 724 Recuadi[innlnp ❑ 130 _ San <br /> k <br /> Huriwntat tVell ❑ - gJ:ave i <br /> Destruction ❑ (de=wnhe a ay gkav <br /> dextrt"c(1nn materials and <br /> 14)in Item S gravel <br /> uced rrrItem - <br /> E (4) PROPOSED USE: <br /> Y I <br /> O.mreetfc [] - 200 gjavlal. � <br /> Trrlintlon [] <br /> industrial <br /> Tat teen ;k f <br /> steel" ❑ _ C I <br /> Municipal cl - <br /> PERF d25 <br /> - WELL LOCATION SKETCH Other [j -• - Il <br /> S1 EQUIPNIENTj ((f) CRAVEL PACK: <br /> ttPed _ l <br /> 1, Diary Q ,tcvcrcc [} Ycs ❑ Nn ❑ Size ` <br /> Cable ✓❑ Air ❑ Diameter of M - p <br /> Other D Bucket Ll Packed front---- <br /> (7) <br /> rom(7) CASING INSTALLED: (6) PE11F'ORATYONS: r <br /> Steel ❑ Ptaadc ❑ Concrete Q Type of perforation or size of xcreen 1 <br /> From To Dia. Cage or From To Slot - <br /> ft. ft. in. Wall ft ft, size <br /> 0 12 It <br /> (9) WELL SEAT.: = f <br /> Was "urErce sanitary seal provided? Yes R lin © If yes• to depth ft- <br /> t <br /> were serrta "baled tmingt poflodon? YeG ❑ No ❑ Interval-.-._.,,,_,r,_,h. - <br /> Methud of ae¢lin' W-k stand 19 Complet S9 _ <br /> (10) WATEIi LEVELS: WELL DRILLER'S STATEMENT: <br /> F <br /> Depth of &rr[ rvater, if knnTkf7 well icQ.r drilled under my iurrFdie[inn arsd Mi. "Chart fr tritE to the best of rst!. <br /> Stnndina lovel after well completion g, knowledxe and beficf• <br /> (11) WELL TESTS; 51car�Was well test made? Yrs C No C II yes. by whnm? (`Nell Drfller) t <br /> Type of test Pump ❑ Il«iler ❑ Air lift ❑ [V <br /> AM <br /> Depth to +rater at siert of tcatft, At cnd of test ft (Pe*aon, firm,or corporation) "a ur printed) <br /> D1"charCe c¢1/rain after t uurY Water temperature Addresa_-12, 6. 139m 908 'F <br /> + - Gib ;p 5 2 0'1 — <br /> C:hc.nicnl analysis made? YL" l� No ❑ !f >ee, by rvtyorr�? <br /> W" eetrie tea �rnde? Yca ❑ No ❑ If res. nRnch cup),m this report Lieansc No 20 Date of thio report <br /> e 9 dairy.7.7et IF ADDITIONAL SPACE ES NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM .ro,a.. Tasom aura Qr vs <br /> c <br /> IL <br />