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• i <br /> • r <br /> ORIGINAL. STATE OF CALIFORNIA Do not in <br /> THE RESOURCES AGENCY n' <br /> File with DWR DEPARTMENT OF WATER' RESOURCES No. 169001 <br /> of Intent No. cJ��� � WATER WELL DRILLERS REPORT State Well No <br /> ormit No.or Dn Other Well N <br /> r L^ <br /> tX <br /> OWNER- t�3ERt v D' ¢ !tG O t (12) WEIII LOG: Total depth�L Depth of completed weU�ft. <br /> rNam <br /> r ` " C) Q h 7 from K to ft•Formation (Describe by color, ohmmeter,size or material) <br /> City C_atcAty_ 7.tp. tj� ✓it_ ,11�r+/ lT Ta ' <br /> {2 Y. CATIQN OF,WELL <br /> � (See instructions): t! <br /> County Owner's Well Nombe `� `�- �` <br /> ZYell address if Brent abov q00 r I pAl r <br /> Township nge ?L Sectio / <br /> 21K-.7 b -I�✓14 j I <br /> 7 .` <br /> Distance from cities,roads,s ilroads,fences,etc ^ �3 G i <br /> �f (3) TYPE Ox WORK: 1�2_ <br /> New Well! Deepening❑ <br /> Reconstruction ® (o C( - r�' '• % Gt� tl <br /> 1'7�j owt <br /> I'°tt;Z0 j Reonndltionfag Q <br /> 1Cy�t :• Horizontal'Well © "�Z• t y��Y,�tiO Sir�- �a ;. <br /> Destnecftoa Q (Describe �'•�i�"y^ � � d�QCs t d <br /> `L <br /> destruction moteflo]s r <br /> procedures fn Item l? <br /> (4) PROPOSED$Sl, <br /> f Domestic <br /> Irrigation 0 <br /> Industrial ` a 0 � e- <br /> Tesi:k,weli Y/ ❑ ,t f '_ �i f v.t f! <br /> -- -F--^ .� "-`•iC -^ '� ! � Stac12`� ,�- •�J�a _ � -��C,st a' <br /> Municipal„ <br /> . t <br /> VYELL LOCATION SKETCH Other e <br /> (5) EQUIPMENT: (a) GRAYEL'PACIC: <br /> Rotary 0Aeversa Q Yes L� No� �_a.• * /t'�� ';_ <br /> Cable ❑ Aft (r -/ Diometer ofbo <br /> a <br /> Other 0 Bucket Q %1,44•Irn 5A.Y. <br /> (1) CASING 1NSTALiZD: 'k-N\. (8)'fERFORATI{O - <br /> steel Q Plastic l( Co zfj� <br /> r sero'[I, Type mF pa oretloa or Size of,acme !1 r <br /> From To r- ,Dia. Gage-oc P'rQm:•1 .../To �.• �`J. <br /> ft ft•(("-,;In. Wall ft•:-� ft /% _•, izg <br /> Z o• �Kg roti Ao 130 <br /> (8) WELL SEAL; / <br /> SYas surfaco sanitary seat provided? Yes(b,' No Q If yes,to depth�2 it. - <br /> Were strata sealed agama pollution? Yes❑ No IaterSRr ft. <br /> Method of seaIfn Work start 9 Com let 18 <br /> (10) WATER LEVELS: ( ? WELL DRILLERS STATEMENT: <br /> Depth of first water, if known_ '✓ ' T'hir_-UwavlgrXed stn er mr <br /> rurltdictlm•and thin report is true to the best of rot/ <br /> Standing level after wen completion_ haourledge r <br /> (11) WELL TESTS: SIG,-ED 2� <br /> Was well test made? Yes(] No Erlif yes, by whom? <br /> ell Drillcr) <br /> Type of test Pump Q Bailor p Air lift p NAM AJE ?'f 1t ti <br /> Depth to water at start of test fL At end of test k (Pa r.Srm, wrporatioa Typed or printed) <br /> Address <br /> ar(e vaI/ada aftcr hours Water tempera rJ r r f <br /> enI analysis made? Yes tJ No[] If yes, by whom? C `) <br /> 1 electric log made? Yes(]' No ff yes,attach copy to this report Zdcence No J7����. nate of this reporty <br /> DWR tes(RSV.7.79) IF ADDITIONAL SFACE IS NEEDED, USE NEXT CONSECUTIVELY NUME3ERF-D FORM <br /> b3 N o 9'E a <br /> J'Fc 2 <br /> /3 . <br /> Records <br />