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STATE OF CALIFORNIA Do Not Fill In <br /> t 1 THE RESOURCES AGENCY <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES N2 89371 <br /> Fite wgth IDWR <br /> WATER WELL DRILLERS REPORT State Well No <br /> Other WelNo '�- <br /> (1) OWNER TT�� (11) WELL LOG: <br /> Name Mar Patlno Hart Electrie -rot.]depth 1 it Depth of completed well 128 is <br /> Address 11100 Satico Ave. Formation Describe by color,character v=r of material end structure <br /> Sun Valle Calif f' '. ft <br /> (2) LOCATION OF WELL Log <br /> l.ounty San eJ oa uin �s Owner s number 1f any 0- 'To soil <br /> ry-t <br /> Town:hip Range and section 12S R —1 Clay <br /> Distance frumeme. roads adroads etc Larch Rd & Tracy Rd 14-19 Sand <br /> 106 Larch Rd.-West of T 19-22 Clay <br /> (3) TYPE OF WORK (check) 22-2- Sand <br /> New Well X Deepening © Reconditioning Q Destroying ❑ 21-27 Clay <br /> If destruction describe material and Procedure in llem 11 27-40 Sand <br /> (4) PROPOSED USE (check) (S) EQUIPMENT 40-44 Clay <br /> DOmtStIC :P Industrial ❑ Municipal ❑ Rotary ® — 2 Sand <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable 52-615 Clay <br /> Other ❑ 65-68 Sand <br /> (6) CASING INSTALLED 68-70 Clay <br /> STEELX OTHER If gravel packed 70-Z3 Sand <br /> SINGLE X DOUBLE Z-1-81 Clay <br /> Gaga Diameter 1 - Sand-120 Clay <br /> From I. <br /> or of From To <br /> ft it Diam Wali Bore ft ft 120-126 Gravel <br /> 2 126-115 Clay <br /> Size ui shoe or well ring Ssze of it—el <br /> Oe.cnbe imne <br /> (7) PERFORATIONS OR SCREEN <br /> Type of pertorauun or name of screen <br /> Perf flows <br /> From To per per Size <br /> f ft row ft in xin <br /> f1 <br /> (S) CONSTRUCTION <br /> Wa,a surlace sanitary seal proytdedl Yes 2 No ❑ To what depth 0 it <br /> Were any [rata."Zed against pollutions Yes ❑ No❑ If yes note depth of strata <br />' From it To ft <br /> From ft to it Work started 1971 Completed I9 <br /> Method of.eal,ng Benton1te WFLL DRILL£R'S STATEMENT <br /> (9) WATER LEVELS This well was drilled under my rurisdretson and thrt report is true to the best <br /> Depth 2L wh.ch water was brie found 1f known k of my knowledge and belief <br /> Standing level before pe'rfot►nng 1f known it NAME p <br /> titandtne level nf[rr perforating and developing 12 is <br /> (Person firm or eorporauon) (T)ped or panted <br /> (10) WELL TESTS- Address 2500 T RUMble Rd. <br /> Was pump test mades Yes ❑ No If yes by whomP _ <br /> Id gal /min with it drawdown after hrs [SIGNED] L <br /> Drr!! ) <br /> rem Pera[ rWe[( <br /> ute of water Was a eheminl analvsss made? Yrs ❑ No L <br /> Was electric log made of well) Yes 0 No If yes attach copy License No 1—.�J-3T122 Dated 10-29—, 19-23 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 1B8 1st Ey g fins <br /> 25179 95(19 6F1 SOM TPS✓'QO OSv <br />