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' SrA7'8 OF CAUFaRN A <br /> ORIGINAL THE ttFsouRCES AGENrY Do not ,fill in <br /> File with DWR DEPARTMENT OF WATER MSOURCEs 361945 <br /> WATER WELL DRILLERS REPORT N0. <br /> I , atice of Intent Nm Slate Wen Na <br /> —Loeal Pcrmit Na or Date l W+ Other Well Nu <br />' (1) OWNEL Name (19) WELL LOG Total depth 145 ft.Completed depth I A 1L!t <br /> Address from k to ft formation(Describe by color,cb=otor,sine or=&ta le]) <br /> Citi' zip 0 — 5 Sand <br />' (2) LOCATION OF WELL(See wstructions) 5 -- 25 clay <br /> Couety owner's Well Xundmr 25 — 35 Blue Cla <br /> Well address if different from above 22Q1 14 wash, 13atnri 35 -- 39 Blue San d <br /> Towltship—�f Range Section 3 9 — 61 Blue C l a <br /> Distance five,cities,roods,milronds,feud etm 6 1 — 6 7 Blue $ <br /> 67 — 108 Bluu e eC1 <br /> 108- 114 F i ae,B I u N&fnd <br /> 114-- 119 Coa lue San <br /> (a)Txm up WOOL 119— 12 5 B I u <br /> New well)f Dmpemng ❑ 1 5— 14CMU u e a n d <br /> Reconstruction p 140— 445 e Clay <br />' Reconditiousug <br /> Hanzm ai Well Q <br /> Destruction ❑ (Desa(be <br /> datructiou pmterlais and Pro- <br /> cedures in Item 12) — <br /> (4) PROPOSED U5ell <br /> f <br /> Donmastic <br /> 1 Irrigation <br /> Industrie[ <br /> r Tat Weil <br /> Ri <br /> Y ❑ — /1 <br /> CA <br /> %VE.L LOCATION 3g8't'CH be) <br /> i57 EQU1111%rMNT CRA L S <br />' Ratm "tx Sesersa ❑ ]Vo S <br /> i'ahte ❑ Air ❑ of bare t <br /> Other ❑ ssmm <br />' (7)CASING DMULLE13- <br /> Eted ❑ PiartieAf asreacaF Q <br /> Fina T Gage or t -- <br /> ft, wa11 <br />' (9) WELL SEAL. -- <br /> Wassarfaoe surklim7 seO wmided? Yes No❑ If yc%to depth 50 ft <br /> Wemstmkaseeledapinstpaiiuum? Yes 0 Na❑ b nval f1. <br /> Method ufmdznEt BENTONITE Work start I:) CeIeted 19 <br />' (10) WATER LEVELS. WELL DIULLER'S STAT NT <br /> �andsngierel� �v IL This well was drilled under rn Jrerlsdlatton and[tine report is titre io the <br /> brae of lay hwmled and balte <br />' (11) WELL TESTS. - ,. Q - - �- <br /> m wait test made? Yea 11 No [N If m by wham? sped [Wdi er) <br /> test P=P © s ❑ Airhit ❑ NAmE HENNIN.GS BRQ5. ❑RILLING7 CQ- a INC- - <br /> m,sateratstartaftest fL At mW oftmt iLiP ar orp� <br /> Dbeharga gal/main after boos t WSW tempamtum Address <br />' c l znah,*=&-e Yes o No IN IFM by whom? City, _MO D E S 1'0 , CA —ZIP 9 93.1i 6 <br /> Wasamtr(alogmade Yes ❑ No IN Ifn Attach tolhisa Lice..Na 2 9 013 13 Datevfthts 90 <br /> DWR 180 9MV.12-M IF Ars MONAL SPACE IS AM-MSD,USE Ng= C4NSjjt3Ur1VIjL.Y HUMS13RED FORM M 9439 <br /> 1 <br />