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�d <br /> �dt7 2 59�� <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill 121; <br /> File with DWR (Seettao7rrp.7064,709L,7012.Water Cada) �© 47502 <br /> • THE RESOURCES AGENCY OF CALIFORNIA 1�j7E3. <br /> DEPARTMENT OF WATER RESOURCES <br /> ��' 011ier We11N I7$ 3F!� a�.�t'►Te�Y <br /> (1) OWNER: (11) WELL LOGt <br /> Natne (;e3or A Fran o Tad&V& 200 ft. Depth of eamplatad well 183 fs <br /> Address 11290 No• 99 fast Frontage road Farenadont Aae lel by for",rb+r■ettr,ttsr Of 0"kr+a1,"d strwow* <br /> North of Mo se RoA-d kXgj ehjnjgje 2 g-tari It to fa <br /> (2) LOCATION OF WELL: house <br /> couvar SanOwast'e camber.If as <br /> Towasht RU aad&cdon 9 <br /> Dutanes from ettia raids cadeowde asc 9 37 <br /> (3) TYPE OF WOR$ (check) <br /> New Nell M Despettiag 0 Retoadwonms Q Destroying <br /> BI - <br /> It4desir-110" describe wderrlat sad praerdxre trs Udw 1l <br /> (4) PROPOSED USE (Check)2 (S) EQUIPMENT: Bra as-nd rA Es <br /> Domestic ❑ Industnal ❑ Municipal ❑ Rotary <br /> Irrigation [R Test Wall ❑ Other ❑ Cable <br /> Other <br /> (6) CASING INSTALLED: <br /> s OALI 6THMRi If gravel packed aneemy pre elwy 78 as <br /> f SINGLE iE nout3L6 p 33w Rama _A5 87 <br /> Gaga Diametcr sandy yapiAble BP slay @q so <br /> From To I or of Ffam To 4-lard— 99 IDS <br /> it ft Drum wall Bore it it, <br /> i <br /> �r <br /> Pr- <br /> size of shoe or well wisp Stu of arsrelt <br /> 1 Derenhe 1019C <br /> (7) PERFORA'T'IONS OR SCREEN: BI-. sand <br /> T of perfaeadoa ar name of tatpn <br /> Peri Rover Croy SiRy 3,62 372 <br /> From To per per Sao <br /> ft fL rove ft. in.xsm <br /> sand <br /> (a) CONSTRUCTION: <br /> Wan a swism sanitat7 seal Tided? Yea❑ No jj To what Aujah fs <br /> Wats strata waled s cast lbation? Yet 0 Na JX Tf M notauptu of tttata <br /> Finac ft to ft 1 um—ow Frfefm <br /> Ftam ft w ft Work at ned 7 it $7 .Completed 10/0- 19 67 <br /> tdethod of VT-U DlUUZ S STATEMENT <br /> (9) WATER LEVELS: Thu wit was drilled under esy)arkdlchora acrd tbu report is erm to the bat <br /> of t»ykno vi dgeaud belief <br /> D h se whteh water was fins fond if known ft <br /> St2ftdrag la+d before perlotating, if known it NAMX 80n joa (s' <br /> st"wing level sitar peryantlaa and dare! is it ( t m,of earpotayoa) (Tyf or prraead) <br /> (10) WELL TESTSt Addrea 600 E Kettlemim Ln <br /> mt muds? Yes ❑ Ne if yes.by whomr J.ndi <br /> L <br /> total/tam wirb it drswdowttsfter her, SI6rtan ry <br /> Tsatpsrawta of wares <br /> Vas*chemitd and Ls rusda? Yea Q Ne 0 _ sr <br /> ®u elccuts to aaadt of wd1) Yea [] Nn ,a ff arteeh a Lw.at No_�t 2206 -Dated. U14 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> 13WR loo (Beer a651 [esYhe[O nWa[aaY TmPOA osP <br />