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ORIGINAL <br /> obtained permit <br /> ORIGINAL. STATE OF CALIFORNIA Do not fill in <br /> le <br /> THE RESOURCES AGENCY No. 168891 <br /> I ;..i, <br /> DEPARTMENT OF WATER RESOURCES <br /> 'WATER 'WELL DRILLERS REPORTstate wellL No or bate __ Olhor Well No <br /> ` <br /> I) 0WN�• Nam (I2) WELL LOG. Total deptb2.32—ft.Depth of cronolated wdl1,7-5-t <br /> ifornia rsti. from ft to It Fetrandon (Doslaibe by Color, chnrncter, the or motvdWa <br /> c,ty _ stQ n, Calif. - __.__z, 08 <br /> (2) LO ATI N OF WELL (gee(nstrlactloos) <br /> -5 Haid Dan- <br /> cou urn Ocveeers Well Number <br /> Well address if different from gba 2 W. Hi hw atm <br /> 6 y o d 6 O Brown clay <br /> Distance from otttes•rower, mth.."rem. to 85 - Hrown sand <br /> $ -- 10Brawn &lay <br /> 309 - 12 5rd'-wn aand <br /> 112 — 11A 4 <br /> (3) TYPE OF WORKi , <br /> New Wall I$ Deepening Q125 <br /> l;econstrnctlon 0 15 6 — 0 O <br /> Iteveaditiowtog 0 ' 170 - 1 gM 1 <br /> gy <br /> Ilodzantal well o 1 Q - r2� .��Hr sand <br /> I)eeM1uet{eA ❑ (Describe "1' •l— 2 (� � G�..r <br /> de= ,.It tl i atedals =7 /7 <br /> .pwccdunm ,e Item 1121]{ �• `♦ - <br /> (4) PROPOSED Uot <br /> Domestic ps±-i V ` i �\ �"•'` (�� �' <br /> Imgallon:F <br /> ;''�h �� s � ♦i <br /> Industnal {] <br /> Test W e1! ❑ .:, .� `\'_ �.� <br /> 510 <br /> \ • <br /> - Muatripalti\ C3 � <br /> WR[T,LOCA'T'ION SXME IE ' '' Other /^��t 0 <br /> (5) BQIAPMENTs (e) CAAVE4-PAC12 <br /> Rotary Z Reverm [I Yesl,29 Na <br /> Cable [7 Air 0 � I)ItNattr aF base <br /> Other 0 Bucket 0 >'ecired h'o <br /> (r) CASING INSMLM,r`- (8) PERFOnATIO $t - <br /> Steel Plastic ❑ Cohgrbtof ljti Type of perJ'ora p or�&e of screen ti•`i <br /> From 1 To - Dfa Gitgao'r Front To { Sa;1"` <br /> h fo 4 Lin won ft p ft "I" \,size <br /> LAN <br /> 55 <br /> (B) WELL SEiALt <br /> Was surface stinitarY seal Provided? Yes 81 Ne 0 If yea,to clep&,gQ___ft <br /> Were strata scaled agaimt pollution? Yes ❑ No Q Iaterval <br /> Method of eea Work started 19 _ Cosaplele I3 <br /> (I0) WATER LEVELSt WELL DMLLER'S STATEMENT <br /> Depth of first tivato, d lmowls Ther well w.drilled under Rey 1,rLdtcNan and thiz repeit is true to the best of mV <br /> Stowing level niter well completirn. __ rs know4rdge ona beW. <br /> (11) WELL TEST& Slcx>:a� 1 Bkkpr,;r_ <br /> Wes well test mode? Yes n No [I If yes, by whom? (WellDrauer) <br /> Type of test Pump r-1sailer[3 Air left:0 NAME. <br /> Depth to water let start of teat�_.ft At cad of tear „Fc (Person,q m,or corporatieoxat-wr Dr 11 (&P3 ped ory <br /> tugs �allmut after_ 1lotess Water tempera Addroa <br /> city TIir1 ock {:�tlif. , _zip <br /> analYs{s rosda? Yea ❑ No❑ E Yes' by xhomP i' <br /> 953 r) <br /> as vloctrtc log made? Yes O No 0 If Yes•attach copy to this report License No .X212 52 tato of this inpor <br /> . DWR 180 (Rev 7 761 EE*ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMEERED FORM <br />