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APR 2 8 1966 <br />' ORIaINAL WATER WELL DRILLERS REPORT Do Not Fill J'n <br /> File with DWR (Sections 7079,7080,7021,7092,Writer cod.) N? 9251 <br />' THE RESOURCES AGENCY OF CALIFORNIA ti4 _ e <br /> DEPARTMENT OF WATER RESOURCES ^State Well No <br /> r Other Wel!No ✓ t� <br />' (1) OWNER (11) WELL LOG: J J <br /> Namey` P ' <br /> '�+ Total depth ft Depth of completed well ft <br /> Address 75-2 — <br /> f__ Formation Describe by color cbe.arrer,uze of materiel and ilrrdere <br /> (z) LOCA TION o,F WELL• <br /> County J Owners number if any <br />' Township Range and SeeE,ea <br /> Distance from cines roads railroads ece 3 y <br /> (3) TYPE OX_WORK (check)• <br />' New Well Q/Deepening ❑ Recondirioautg ❑ Destroying ❑ — C _xz� <br /> If destruction,deicribe material and procedure in Item I 1 <br /> (4) PROPOSED-USE (check)• (S) EQUIPMENT: <br />' Domestic dustnal ❑ Murucipal ❑ Rotary <br /> Irrigation ❑ Test Well p Other Cable <br /> Other <br />' (6) CASING INSTALLED <br /> STEEL OTHER If gravel packed <br /> SINGLE C IJOUBLE ❑ <br /> II I Gage Diameter <br /> From To I or of From To <br /> it it Diam Will Bore ft_ ft <br /> S9 /,7, <br /> Size of shoe or veil ring Size of:ravel <br /> Describe ioint � <br /> (7) PERFORATIONS OR SCREEN <br /> Type of perforation or name of screen �� 1 <br /> t <br /> Perf Rows WCtr'T c 7 c <br /> I From T per per Size <br /> ft71ft row it in x in <br /> Ir <br /> (8) CONSTRUCTION- <br /> Was*surface sanitary real provided? Yer O No E To what depth ft <br /> Were any strata.wiled against pollution? Yes ❑ No❑ IF yet ante depth of strata <br /> I From ft to ft <br /> From ft to ft Work started %,5, 4p Completed 7^ (e, 19 <br /> Method of nal,nR WELL DRILLER S STATEMENT <br /> (9) WATER LEVELS, This well was drilled under my jurisdiction and tbts report is true to for best <br /> Depth at which water was firse fauad if known it of may knowledge and belief <br /> Standing level before perforating ,( known It NAME �J~UjO � <br /> Standing rfontmg and developing level after it (Perron firm,or corporation) (Typed or pfiseed) <br /> (10) WELL TESTS: Address f3 d-c z C, 3 2- <br /> ^omp tett made? Yea ❑ No ❑ If yes by whom? <br /> = gal/min with fr drawdown after hrs SIGNED] <br /> I empersture of water Waa a chemical analysti made? Yes ❑ No ❑ y (Well Drdler)) <br /> mr <br /> Was electric log made of well? Yes [] No Q If yet attach copy License No /`') L IL are,, <br /> SKETCH LOCATION OF WELL. ON REVERSE SIDE <br /> DWR I98 iRev 9 as1 Begot 0W re'sl sone rRI}QQ A asp <br />