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7 <br /> ORIGINAL STATE OF CALIFORNIA Do not fill to <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 153493 <br /> tIntent No WATER WELL DRILLERS REPORT State Well No <br /> L emit No or Date Other Well N.,OzSOSE.9D <br /> (1) OWNERName Jim b (12) WELL LOG. Total depth h Depth of completed we1L200ft <br /> Addie •O• Box 845 from ft to ft Formation (Describe by color character size or material) <br /> i,ty Ripont RiponCa. 49 5 3 66 - <br /> (2) LQCATION OF WELL (See instruehons) _ <br /> County Owners Well Number - 48 <br /> Well address d different from above 12 — f6 Sana <br /> L�y <br /> Township e"r_? Range Sectio 4 — " a <br /> Distuace from titles roads,railroads, fences etc <br /> z S <br /> 72 - 92 Cl sand streaks <br /> 2 - San <br /> (3) TYPE OF WORK <br /> New Well X Deepening ❑ <br /> Reu>nstxuctiun ❑ 20 71 <br /> Reconditioning ❑ <br /> lionzontal Well ❑ <br /> Destruction ❑ (Describe -1 <br /> destruction materials <br /> procedures in Item I1: 1 -1 <br /> (4) PROPOSED\ 1 C �+ <br /> DomestiL 15 z 3 Sand,(--,, <br /> lrrig ition �`\� ❑ 15 C1 <br /> Industrial ` <br /> o X 195 Sand <br /> T"" ell ❑ — <br /> Stoc \ <br /> Mumup <br /> wLLL LOCATION SKETCH Other ❑ — <br /> 5) EQUIPMENT (B) GRAV ACK Ro <br /> n <br /> Rotary ] Reverse ( No Size <br /> Cable Q Air ❑ Iter of bore <br /> Other ❑ Bucket ❑ fain t <br /> (7) CASING INSTALLED (8) EAFORA 1 <br /> Steel ❑ Plastic ❑ Cu a Type of pc �or c of scree <br /> From To Dla Ga F" <br /> \,� To <br /> Ga" - <br /> ft ft i r In Wall ft ft. / sl - <br /> 0 2 6 <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If yes, to depth--ft <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval_���t <br /> Method of sealin• Work started 19 Complet 19 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water, if know ft This well was drilled under my pirudiction and thts report is true to the best of in, <br /> Standing level after well completion ft knowledge and belief <br /> (11) WELL TESTS SIGNED <br /> Was well test made? Yes ❑ No El If yes by whorO (Well Driller} <br /> Type of test Pump C) Bailer ❑ Air lift ❑ NAME <br /> DLpth to water at start of test ft At end of test ft (Person, firm, or corporatio '( rtat <br /> aP <br /> arge -- gal/nun after hours Water tempera Address <br /> analysts l- <br /> m ade? Yes 0 No ❑ If yes, by whom? City p � <br /> Was electnc log made Yes ❑ No [) If ves attach copy to thts report License No ate of this repo <br /> 0WR 188 (REV 7 Tal IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />