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Om/«s/wALFile Original OUP11tafe and Triplicate wilh The q <br />, DIVISION OFsHE�WATER RESOURCES E 2 <br /> WATER WELL DRILLERS REPORT Do Not Fill im <br /> (Sections 7076,7077,7078,W2ter Code) ScateWellNo <br /> Other Well No <br /> Region <br /> (7) Perforations <br /> Tvoo of perforator uoel-----_--- <br /> - - ' ---- --' - --' <br /> Ie6oracmf--''- _ -_ --f� u, f, }fo� ,p"- -- -- '----- -- - - <br /> . _ --- -- '---- e- -'_ ----- --�Ju of holes -_ <br /> ------ -- -----. ~ . ^' ~ ., ------- <br /> . - _ -__ -__ <br /> -' --- ------ ---- <br /> . - ---'_--__ . ~ . . ~ - - -- --- - - ----__ <br /> -_ -- -- --'__ --' --' -------- . .' . <br /> . ~ ~ '----_ _ _ --------- -- -_ <br /> __- _____ ~ ~ . <br /> ^' -----'--' ' ~ . _-_--- --__ _ -- --_- - <br /> ---_- -- -- -------------'---- <br /> ----_-_ -- . ~ . <br /> ~ ' _--'- '-' -- ^. ~ '' . ~ ---'--_ -----_ '--'----_ <br /> " --_ -_---_-----'----'-' - _ --------'-'-__ ~ ° " ----__- <br /> -'----'-'--'--- --'-~ °'-- _--'---'-'_----^. .. ~ ------ -- ., .. .. -__-_- <br /> . -'---'--'--_-' ^^ .. - _---_'-' .. .. ., <br /> ~ -- ~ ° . .. . -------' - ---'-- _ <br /> �������--'---'--- -__'_--'-'-_'---'-_'- '- _-----------------'----' <br /> (g) Water levels: (e) Well pumping test- <br /> Depth ut`phxd, vrxt,r Date oftest---------- -----Bywhom <br /> �otencountered_-_-- ----']��'-'-_-_--ft Depth to water when test started -- -- ----'--' '--- -- --- '- <br /> I�opt6towater ��PD� ntbeginning oftest — -'---- --- —'--- —�� <br /> ,�u"6/u� l�"� <br /> before perforating'--' _ fc Drawdown fromL '-'-'----''--' -------- '�t' <br /> Depth to water ��P&{ at completion of �mt_'------- ------ -- ' --..--'z <br /> t. <br /> . after ge�on^�u��-'--'- '----'---- -_-ft Drawdown at completion of test <br /> ---'--------- -' '--'--'--- <br /> ���� I�v,eany change uur,a�rlevel n/6Je6olbno Length of time tested--- ---''-- ��--- —� � -----_� �-- -z�' <br /> zouzyerutu,= of v,xcor- -'---' '-'---' _ ---' - - - ' <br /> Was gas present /uwnteO [] Yes P No <br /> (10) General. <br /> Was well gravel pxckc6�'--- --- - -Size of rock -' -- - -'---T6ickoem of pack <br /> Was a surface vxcutary ,rul provided' - - ------------- - '- ---_ -' --_--- '--'_' ---------' —- <br /> vvvrc any strata scaled against 2o\6^tx,o* [I Yes F-1 No If yes, uzcxc6 d,tm)c6 description <br /> Strata scaled----------'-------- '--'--------- <br /> Was analysis <br /> ----VyaoxnxJyav made ofwater) Fj Yes 0 No If yos, utcw;h copy - - '-- — <br /> Was electric log made of well, C1 Yes Ej No Ifyes, attach copy <br /> If Well abandoned, was /t p6urue6 and seale6�---------------------------. ------- -- <br /> Method <br /> Modu,d f plugging and sealing-- <br /> Location <br /> l '--'' '--- ----- ---'' <br /> North Section No T"*-4- <br /> -Z --r Work started date- Completed date <br /> Township --- Date of this report <br /> Range <br /> Base&Meridian WELL DRILLER'S STATEMENT <br /> Show location of well in Sec- This ivell was drilled under -my jurisdiction and this <br /> -tion,thus (X) report is true to the best of my knowledge and belief <br /> Distances to section lines from <br /> well, N or S JR 411- fr [SIGNED] S:T09CK N AFLMAT�� <br /> Z-~- Show ..-~^^.^^ of ^^°^^",^ By <br /> known well, thus ((J) <br /> i MILE Distance m nearest known LicenseNw�6?45O <br /> well ft Dxu6 tl J" -17 <br /> ovvnFORM m" 245 REGIONAL WATER rwLcuTzOxv cOmTmoLaOAan rop' <br /> -----__----' - ----_ __--- - -- --_ --_-------_ -_----- ----- <br />