Laserfiche WebLink
ORICpINAiL STATE OF CALIFORNIA <br /> Do not fill to <br /> File with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 0 9 8 3 0 55 <br /> Of Intent 10pp WATER WELL DRILLERS REPORT State %M1 ell 10 <br /> Lns t Penna No or Hate -8 6 r�..- <br /> Other Well No <br /> OWNER N,n,e-Ra_f 12 well ft <br /> �L <br /> �-t� � � WELL LOG Total depth 1401t Depth of completed <br /> Address 21 2 lZ'�(' B1�7d • from ft to ft Formltion (Descnbe by color character size or mater,]) <br /> clt. Trac CA Zip - I top scil <br /> (2) LOCATION OF WELL (See tnstructlons) <br /> Count\ Sa 12 J=o u1n Owner s Well Number 1 - 20 <br /> d <br /> «'cll address if diHcrent from ahme 20 - 21 clay <br /> Towntih,p Range Sectio 21 - Q sa nd <br /> Dutince from cities roads, railroads fences etc d 1 0 - 0 C' a <br /> mile north of Hwy 20 n est 3.de 80 - 8 fine sand <br /> 8 - a <br /> 14 - 116 f ine sand <br /> (3) TYPE OF WORK 1 1 6 -' 1-21 \ 1 <br /> ay <br /> "c%% NN ell a Deepening ❑ 121 28 2ravel and sand <br /> Reconstruction D 128 - 140 clay <br /> Recondition imz ❑ _ <br /> Horizontal X%ell ❑ _ <br /> Destruction ❑ (Describe - <br /> destruction matenals and <br /> procedures in Item I2) - <br /> (4) PROPOSED USE - <br /> Domestic _ <br /> Irrigation ❑ _ <br /> Industrial ❑ _ <br /> Test Well ❑ <br /> Stock Cl _ <br /> Municipal 0 -WELL LOCATION SKETCH Other ❑ _ <br /> (5) EQUIPMENT (6) GRAVEL PACK Woodland - - <br /> Rotary Pg Reverse ❑ Yes.] No ❑ Srz 11 Sqn.d-- <br /> C ihle ❑ Air ❑ Diameter of bore I If <br /> Other D Bucket ❑ Packed from 0 m� ft <br /> (7) CASING INSTALLED (8) PERFORATIONS _ <br /> Steel ❑ Plastic © Concrete ❑ Type of perforation or size of screen - <br /> Froin To Dia Gage or From To Slot <br /> ft ft in Wall ft ft s.ze _ <br /> 0 - <br /> (9) WELL SEAL _ <br /> Was surface sanitary i seal provided" Yes No 0 If yes to depth—_'7L; --ft _ <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft _ <br /> Method of sealing.- Bentonite Work startI9 Completed 19 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if knowtt_ - k This well u.as drilled under my Jurisdiction and this report is true to the best of my <br /> Standing level after Kell cumpletio g knowledge and bgliet <br /> (11) WELL TESTS Stc�>rn_ <br /> Was well test made Yes ❑ No 79 If Nes by whomA (Well Driller) <br /> Tvpe of test Pump ❑ Bailer ❑ Aur lift ❑ <br /> NAME sr C <br /> Depth to ,eater at Start of test ,Y,_ft At end of test R (Person firm or corporation) (Typed or printed) <br /> irge gal/mm after hours Water temperature Address`52 Peiandale Avenue <br /> lea] analysts made" Yes o City Modesty Ca jX-{?,,o iaf10 �yi �953� O <br /> ❑ No�] 1E yes by wham �t� � mai rs4+• - 2SIP....�- <br /> ,dj <br /> ' s electric log rrinde% Yes © Ifo X If ses attach copy to this report License No 2908 ` I -Date of this repo 0 <br /> R 188 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM r �� <br /> a tiS <br />