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QRIGIMAL STATE OF CALIFORNIA Do not fill in THE RESOURCES AGENCY File with DW$ DEPARTMENT OF WATER RESOURCES No. 154224 of Intent No WATER WELL DRILLERS REPORT state well No Permit No or Date owner got permit Other Well hu O ZS6SE/ ` +7 1617 OWNER Name J . V . But1er (12) WELL LOG Total dep9h—L_9Rft Depth of completed 190well 9 0 it Address 10723 W. Larch R d . from ft to ft Formation (Describe by color character size or material) City Trac Ca Zip 9537b 0 - 4 Top Soil (2) LOCATION OF WELL (See instructions) Countya q i j 1 n Owners well Dumber a n ` Well address if different front above 43 62 Clay Township —RangeSection 62 _ 71 /San d Distance from cities roads railroads fences etc ��if 0 1 West of 71 - 84 C I a Irary Ave , 84 - 86 Eine Sand rth side 86 - 154 Clay 154 - 156 Fine Sand (3) TYPE OF WORK 156 - 170 Clay New «ell h1 Deepening ❑ 170 - 182 nSand & Grave 1 Reconstruction ❑ 182 - 190 Clay Reconditioning ❑ _ Horizontal Well ❑ - Destruction ❑ (Describe - destruction materials and procedures in Item 12) - (4) PROPOSED USE - Domestic Irrigation ❑ Industrial ❑ - Test Well ❑ Stock ❑ _ Murncipil (❑ - -' WELL LOCATION SKETCH Other ❑ - t 5) EQUIPMENT (B) GRAVEL PACK Sand & - Rotary I Reverse ❑ 1 e LX No ❑ size Gravel - - Cable Air El Diameter of bon- Ii - Other ❑ Bucket ❑ Packed from CJ to r 4 H - (7) CASING INSTALLED (8) PERFORATIONS - Steel ❑ Plastic [X Concrete ❑ Type of perforation or size of screen - Froin TO Dia Gage or From To Slot - ft ft in Wall ft ft size - (9) WELL SEAL y� - Was surface sanitary seal providedO Yes IN No ❑ If yes to depth_____5_0L_k Were strata sealed a ainst pollutiou2 Yes ❑ No ❑ Interval ft _ 1 Method of sealing- b e n t o n i t e Work sta UCt. I —19_L3_4Completed-19— (10) omplet 19(10) WATER LEVELS WELL DRILLER'S STATEMENT Depth of first water, if known This well was drilled urider my jurisdiction and this report is true to the of my Standing level after well completio ft knowledge a eleef (11) WELL TESTS Sicvsn Was well test made Yes ❑ No X If yes by whom? (Well Driller) Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME H E N N I N G S BROS. DRILLING CO . , INC . Depth to water at start of test ft At end of test # (P,Pr�vvpp �irra�i,tt�i o ra w�n/)C(Typed or printed) ''^ Address 3525 �tLHIVU�� y L . D' urge gal/nun after hours Water temperature ' j -al analysis made? Yes ❑ No If yes, by whom? 'C' 75P electric log made% Yes ❑ No If yes attach copy to thisrreport License No,* 90813 Date of this repo IR IBB (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM