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ORIGINAL STATE OF CAL,IrORNIA <br /> Do not fill in <br /> THE RESOURCES AGENCY <br /> File with DWR <br /> DEPARTMENT OF WATER RESOURCES No, 248089 <br /> f Intent .n WATER WELL DRILLERS REPORT <br /> D^—1 1 5 Siete Weli No <br /> ,mitt Vn or D1te �.t <br /> Other Well ti'nOzSO�-�" Z <br /> ( 11 OWNER Vane uST--Ie Sparks ( ) Q <br /> -�dclress <br /> 1551 Buena T/is ta. Ii vLm. `12/ WELL LOG Tot21 depth 1,/�It Depth of completed wcIL1 93 it <br /> 'Y from ft to ft Form ittnn <br /> , vermore , a (Descrihe bs color character size or matetaal) <br /> Lip <br /> (?) LOQMOI OF WELL (See Instructions)tions) 3 - � � a� <br /> CnUntv_. Tan oa�uln Osv Hers Wr 1.). -. <br /> Well Number 43 L a 7 Jr1a e <br /> «'eI[ iddm%s if different from shove Pa t vers on Pass �{1',� �^, 5 r7�37 - dee-G -San <br /> Ttittnship Ran,e _ / f <br /> Sectio - 85 Shael <br /> D'stince from cities roads railroads fences etc Dat vers or, Pa -,3 2�� - 1 0 j Cla' <br /> oro 105 - 114 :hael <br /> north �fre5t sle <br /> ay, <br /> i Z:11 <br /> 1 Sha <br /> (3) TYPEOF WORK a n y e <br /> '1ew Well X Deepening [] 1 `✓�♦ J v aY <br /> `. al <br /> Re(nnstruchnn 0 155 - zl 4 Cla <br /> Reconditioning ❑ ^1 4 - 192 Black Sand <br /> Horizontal Well ❑ ',1 ta�t <br /> 1 7 14 2i <br /> Destruction ❑ (Describe <br /> destruction materials and <br /> Procedures in Item 12) <br /> (4) PROPOSED USE - <br /> Domestic y _ <br /> Irrigation <br /> • Industrial Test W ell <br /> Stack <br /> Municipal <br /> WELL LOCATION SKETCH Other - <br />�) EQUIPtIENT (6) GRAVEL PACK J=�-" -elfM <br /> r, �� Reverie ❑ Yes ] do ° Sizeable 1� Air ❑ Diameter of borerr-,� 1t <br />)ther ❑ Bucket ❑ Packed from�V <br />') CASIWC INSTALLED (8) PERFORATIONS <br /> S - <br /> teef EJ Plastic Concrete Gh Type of perforahou or size of screen _ <br /> From To,, ,Dia Ga <br /> gear From,-, To 'r Sloi: <br /> ft ft t in Wali ft"\\ ft <br /> 0 1 1 0 15 193-, screen - <br />)) WELL SEAL _ <br /> as tiurface samtary seat provided" Yes If yes to depth-,iC_ft - <br /> ere strata sealed againsto11 tion" Yes No ft <br /> thi)d of sealin fMonate ❑ Interval - <br /> 0) WATER LEVELS Work stated o 19 Ccimplet <br /> pth of first water if know <br /> WELL DRILLERS ST kTEMENT Is <br /> tnding level after well Completupi>_ Q t Thu melt was drilled under rag purtidretion and aas re port trrr <br /> (.t knowledge a belie/ J c to the best n) my <br /> 1) WELL TESTS <br />�s well test made' SIC`ED <br /> Yes [' Vn � If yes by whom) <br /> ve of tevt pump ❑ Qiuler f] air lift (Nell Driller) <br /> ft ° HENVINGU RILL u C0. 3 Ii, <br /> v��rE S Br�05. D Cr. � r <br /> oth d) vatcr it start of test At end of test St <br /> Persson firm or cn )ration) {Typed nr printed) <br /> al/min tfter Finurs Water temperature Address 352-) 1 e l andale Ave. <br /> tnalysis made ?535 7 3 5 <br /> Yes ❑ No If Yes by whom" city1Vlodps do Ca y <br /> s 0—tnc lot; made; reS Zip <br /> � <br /> ❑ No If ties attach uppv to this report License Vo ?Q01 3 i Taate of this report--L=1 Oma? <br />(R 168 (REV 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />