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9TAtr!OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGISNCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 262045 <br /> ice of Intent Na State Well Na <br /> meal Permit No or D ite Other Well Na Q <br /> nls 04 EE= <br /> (1) OWNER Name (12) WELL LOG Total depth,29- _ ft Completed depth 2_ft <br /> Address from It to ft Formation (Describe by color ch.iracter size or material) <br /> City ZIP <br /> (2) LOCATION OF WELL (See Instructions) <br /> County Owners Well Number — — — ned, <br /> Well address if differ nt from above <br /> Township Range U a Section TY t <br /> Distance from cities, roads, railroads, fences etc _ <br /> w <br /> - t- - ed, <br /> 12 .5- 14.5, CLAY.\ r 1ty, <br /> (3) TYPE OF WORK 'sd <br /> New Well C3: Deepening ❑ 14 — <br /> Reconstruction ❑ _ <br /> and <br /> Reconditioning ❑ 6 <br /> CLA <br /> Horizontal Well ❑ rust <br /> Destruction ❑ (Describe \ <br /> destruction materials and pro- — ed <br /> cedures in Item 12) <br /> (4) PROPOSED US _ i TT <br /> r= <br /> Domestic <br /> <� <br /> Irrigation — - ^G ed <br /> Industrial ❑ J, _ i� <br /> Test Well �� ❑ _ d v vL m >„- <br /> Other 2* - M CF;AY, mottled tan rust and ahalky <br /> WELL LOCATION SKETCH <br /> �IIe�er>be)Nlonatoring . white <br /> (5) EQUIPMENT J6�GRAVEL PACK <br /> 26— VERY SILTY CLAY reddish <br /> Rotary ❑ Reverse © ta�fr7 No ❑ Size Zro 7 27 SAND multi-13.thic — ed, <br /> Cables ❑ Air ❑ 1� et of bore <br /> � angular. <br /> ocher 14® Suck P�ciedfrom �7 — to, 79 {t M1 27' 28 CLAY, tan brown szl <br /> ty. sandy- <br /> -28 — 29 SAND multi. lithac <br /> (') CASING INSTALLED (8) PERFOR-%TION) - grained, angular, wel l- <br /> Steel [] Plastic 12 6nZxie�❑ Typf of Retforauon or size olftrfe[lFrom TO Dia Cage or FbDm Tcs ` /$10t <br /> ft ff� ' 11t i Wall ft�� t !size — <br /> o <br /> (9) WELL SEAL - <br /> wassurracr s ritary seal provided? les [T� No ❑ If vex to depth 7^ft <br /> Were gr4A%riled against pollution? Yes ❑ No ❑ Interval fL — <br /> Methodofscahngcement/bentoniteu Wort,started JU1 1`>�$ Cnmpleted 19�� <br /> (10) WATER LEVELS WELL. DRILLERS ST,%TEMENT <br /> Depthof first water if known Ft <br /> This well uas drilled render rriV lurisrftct:rni and this rrpnrt is tare to the <br /> Standing level after well completion 1 _0 5 Ft best of my knowle��1a d fief <br /> (11) WELL TESTS 5ignrd ,. r -- <br /> (We Duller) <br /> 'u well test made> Yes ❑ %u [2 If yes,by whom? <br /> .of lest Pump ❑ Bailer ❑ Itirlift ❑ NAME <br /> lh to water at Stan of test ft At end of test ft tPcrwm inn.or�ro rations rTy or printed) <br /> UP-harge gal/min after hours Water temperature A`Idress <br /> -4 Z16 95e <br /> Chrmic-2l analysis madell Yes Qt %o ❑ If yrs,by%hum? City e ZIP <br /> Was electric 1made yes ❑ No If yes.Attach cop tothis report LYCCItSr\n ` Date of this report <br /> own 188 tira 12-8et IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 56 %353 <br />