Laserfiche WebLink
' SrATE!OF CALIFORNIA <br /> ORIGINAL TH6 RESOURCES AGENCY Do not fill in <br /> Fele with DWI% DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT NO. 366340 <br /> otico of intent No „ State Well No <br /> Local Permit No.or fate f o i” z 9L ` 5 A/ Other Well Na <br /> (1) OWNED. Name (12) WELL LOG Total depth 240 .ft Completed depth 2 3 5 ft <br /> Address : rt 4 6 JJM jr 9 ri from ft to ft Formation(Describe by color,character,sm-or material) <br /> City —ZIP — <br /> (2) LOCATION OF WELL (See Instructions) 3 — <br /> County SaM 70FIC111130 Owners Well Number <br /> Well address If different from above 95 — Jay <br /> Township Range Section 102 — ay <br /> Distance from cities,roads%railroads,fences etc — <br /> r -- 157 CQa _om 241 co <br /> 1 (3) TYPE OF WORK ` ay <br /> rlf New Well {Deepening ❑ <br /> Reconstruction © 1 R 9. — Y <br /> Reconditioning ❑ <br /> Horizontal Well ❑ = hlqr-k sand and <br /> DastrucftanNS (Describe <br /> destruction materials and pro- <br /> f cedures to Item 12) <br /> { {4} PROPOSED USK _ <br /> ( 1 Domestic �� ''fi _ <br /> (« `� Irrigation <br /> Industrial El <br /> Ilk Test Well p <br /> Muntct VVV ❑ <br /> AZ <br /> o 1 ) - <br /> WELL LOCATION SKFrCH oche) <br /> INS <br /> (5) EQUIPMENT �CSAV Cg — <br /> Rotary F-1Reverse ❑ Cl No X 5 <br /> Cable Air ❑ AIN bore 4, <br /> Other ❑ Buck ed�rom t <br /> (7) CASINGINSTALLEI> (8} PFR t3 ATIIDV, \ _ <br /> steel Plastic 111:,, Ty oI f ottocatzeoF Q _ <br /> From a_ Gage or 1 t <br /> ft f t Wei! t size <br /> 0 22_,,_ ` . 156 <br /> (9) WELL SEAL <br /> Wassurface sanitary seal provided? Yes gk No ❑ If yes to depth 100 ft <br /> Weradmtasealedagminstpollution? Yes❑ NoNX Interni ft -- <br /> method of seohng Work started 10— Completed Der19 9 218 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Dapth of first water if known ft <br /> StaadmglevalafterwellCom Completion ft This well wa d led under mr furfsdiction and this report is Irue to the <br /> p base of mi nd Belie <br /> (11) WELT, TESTS Signe <br /> Was well test made? Yp El No Gt If yes b whom? (Well A <br /> Peof test Pump ❑ Bailer{ Ajrhft [I ME Tho ur ':?EII Dx it 1n1 <br /> eplh to water at start of test ft. At end of test ft 6 2 8 1 1Persnn Srr 9r corrrt,an)(Typed or prated) <br /> D'ichorge gal/mm after Lours Watertemperatura Address r reo kfl Chemical analysis made? yes ❑ No 0 If yes by whom? City V a l I� � 1=171 `' Zlp9$2 5 2 <br /> Was electric log taade Yes f� Na ❑ If es,attachrnpy to Ihur t f acease No, 3 91 5 4 2 - Date of this report <br /> OWFt 31M(REV 12-86) IF: ADDITIONAL SPACE IS NEEGBO, USE NtU(T' CONSECUTIVELY piUMBEREO FORM 06 96777 <br />