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ORIGINAL <br />0 I with DWR <br />of Intent No. 160220 <br />twit No. or Data _78-847 <br />(0 O'U <br />C <br />STATE OF CALIFORNIA Do not ftal in <br />THE RESOURCES AGENCY fit129445 <br />DEPARTMENT OF WATER RESOURCES <br />WATER WELL DRILLERS REPORT <br />(2) L `5 N1 e�7 Oa?Ul4yL' ( See butractions) : <br />County Ownees Well Nt <br />Well address.jf dl�erent from above <br />Towns <br />Distance from cities, roads, railroads, fences, etc. Same a I <br />hAN t Ow ^eP v ^nA <br />lLOG.Total ii ft. lDopth of completed ii t. <br />De"U by color, chamew. size or material) <br />i r •.a_ <br />■ •• �T <br />141 <br />i���- <br />DWR lee (REV. 7-78) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY VU413AED FORM <br />(3) TYPE OF WORK: <br />Emu PuEttt <br />-New Well If Deepening ❑ <br />Reconstruction p <br />— <br />SIP <br />�!® �,In <br />Reconditioning D <br />— <br />sand layers <br />a <br />� <br />® <br />03 <br />4 <br />}Corizontal WeR ❑ <br />Destruction ❑ Meacribe <br />destruction materials <br />procedures in Item <br />(4) PROPOSED <br />Domestic <br />Itrigation [ <br />— <br />Qn <br />- <br />Industrial D <br />T well ❑ <br />er 1 cover was installed on <br />stoe <br />ls- <br />w I am not responsible' <br />Mnnieip <br />Other D <br />for <br />r�.ng or removingof the <br />WELL LOCATION SKBTCH <br />(5) EQUIPMENT: (a) GLIA <br />Rotary Ex Reverse ❑9" -, <br />Cable 0 Air ❑r <br />Other ❑ Bucket ❑ <br />No Si <br />of bore <br />f t 200 <br />— <br />(7) CASING INSTALLEDa E8) ERFORA .j. <br />Steel ❑ Plastic � Co Type of pe or YSi sece <br />^* <br />— <br />From To Dia. Ga o- <br />ft ft itt. wall <br />To <br />£t ft. <br />X <br />_ . <br />(9) WELT. SEAL: <br />Was surface sanitary seal provided? Yes.V <br />No (3 If yes, to dw Q <br />Were strata sealed against oilutim? Yes ❑ No?} Interval,® it <br />Method of se ('�lilent <br />NVork smrw <br />Complet 18 78 <br />(10) WATER LEVELS: <br />Depth of first water, if known <br />Standing level after well comp] <br />ft. <br />WELL DRILLER'S <br />This welt <br />kaowtedK <br />Sltx <br />STA MENT. <br />tied under furtadict an is re ri true to the beat of rap <br />Ed <br />(11) WELL TESTS: <br />Was well test made? Yes ❑ No:) If yes, by whom? <br />Type of test Pump ❑ Bailer ❑ Air lift ❑ <br />Depth to water at start of test %+. At end of test it <br />NAMi, <br />` D+ ) <br />�aner0 w{~1 2 �i-Ilying�` Inc • <br />i, ( g�s '7�toorgm�j�) (Typq�gapr�ttad) <br />Oa ree <br />tBe vaI/min after h<u.ra <br />analysis made? Yes ❑ No ® <br />as electric log made? Yes D No Fl <br />Water tempera <br />If Yea. by whom? <br />If Yea. attach copy ro this report <br />Add,. -3.491 <br />+'one 7 #t CL <br />Lioanse Ale <br />Oakdale, G`a �f. 95561 <br />rope 6/2-5/78 <br />DWR lee (REV. 7-78) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY VU413AED FORM <br />