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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> file With bW�t THE RESOU RCHS AGENCY -not <br /> 244097 <br /> DEPARTMENT OF WATER RESOURCES <br /> f lotent No WATER WELL DRILLERS REPORT State Well No <br /> ermrt No or Dat /6._ Other Well Nn. ;—P 0 <br /> (]) OWNER[ Nem (12) WELL LUG Totat deptb.—Q92-ft Depth of completed wclLZM t <br /> Address /9n2 UJOZA from ft Formation (Describe by color character size or material) <br /> Clty f- <br /> (2) LOC'�O1�Iaf LI EL (See instmehons) — S <br /> and <br /> County Owner's Well Numbet Gravel <br /> Well address if different from above rt v 130 Clay <br /> Towrohi nga_ Sectio 130 ^ -144 Sari /' <br /> Distance from cltfas toads,roLroaris fences,efa <br /> f ;- ) D .$n <br /> u- ! 1 -- if i;la <br /> 6 - l Sand <br /> (3) TYPE OF WORK. 1 1 f 20Clay <br /> New Well lK Deepenint• C 206 200 Sand <br /> Reconstruction o1208 2 la <br /> Reconditioning E] ^ <br /> Horizontal Well Q <br /> Destruction 0 (Describe <br /> destruct <br /> ren mnterlals <br /> wF 1� procedures <br /> (4) PROPOSED <br /> Irrigation � ❑ <br /> / <br /> Industrial <br /> 1T-v <br /> ( Tis Well 0 - <br /> Stack\ � Nw <br /> WRI.L LOCATI X SKETCH N, lother (^� ❑ <br /> (5) EQUIFAIENTr (e) GR/A `1 ACH tiff' y <br /> Rotary (g Reverse ❑ No iY <br /> Ciblo Q Air ❑ i' D1 e l f bora <br /> Other 0 Bucket Q Pita froo_ t y <br /> {7) CASING IlYST r t��^ (S) Y>;RFOAAT{OIlrs - <br /> Steel ❑ Plastic Co\ te, Type of perf b or size of screen s , <br /> From To { 'Dix Gag -,of 1;x S`+ � TO <�o#`"�� <br /> ft. Ft li� Wa�I ft �� ft .`sizes <br /> (9) WELL SEALi <br /> Was surface sanitary aeal pronded? Yes er"" [] If yes, to dep1b—T —tt <br /> Were strata sealed against pollution? Yes ISS Mu 0 7ntervat ft <br /> Method of scaling__. Bin Wank started 19 Complat p <br /> (10) WATER LEVELS. WELL DRILLER'S STATEMENT <br /> Depth of first water if know This [cell teas drilled roof r my funsdtctfon arul this report Is true to the best o/ my <br /> Standing level atter well aompletfo L knowledge and f <br /> (11) WELL TESTS t SIGN <br /> Was well teat made? Yes ❑ No P-1<yes, by whom? ItiYe11I] <br /> Wt O' ° <br /> Type of test Pump {] Bailor❑ Ale ❑ t�AA�iF: alwa'( er <br /> Depth to water at start of test h At and of lark it 30 <br /> Df coo gni/coin after [.suis Water tempera Add O C a Orn1a jL�C[953 <br /> l� <br /> t kl amlvsis made? Yes Q No ❑ If yes, by whom? Glty. <br /> W electric Ing made? Yes ❑ No Q If yos attach copy to this report Licensa No- t ' y 1t this repo <br /> WR 158 (AEV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />