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STATE OF CALIFORNIA Do Not Fill In e <br /> THE RESOURCES AGENCY <br /> ORIGINAL 0*_% = - I -AL I GEPARTMENT OF WATER RESOURCES <br /> ®with®wR heater Code ;e`3- R WELL DRILLERS REPORT State Well No. <br /> Other Well No �',Z' <br /> (1) OWNER: ! iJ t h.(,t' ' (11) WELL LOG: C <br /> 'SR� T6NS U >A I (qhs Total depth 1 106 fr. Depth of completed well 196 ft. <br /> Address!-(91E Harney rney ame Formation: Dercribe by color,character,size a/material,and structure <br /> O 9 Gin 1 e fr.to fr. <br /> (2) LOCATION OF WELL: /0 4 ter soil <br /> County San Jo a.clu in TT Owner's number,if any r� `t 41 hard na n <br /> Township,Range,and Section 1•j��` N R— —E Sec. 22 r. 7._rdn,q_ %! ,-^�f,^. <br /> 2 h. _r, <br /> .e <br /> Distance from cities,roads,railroads,etc. Sou L 11 S u5. 0 Harney 7)P ^� bro• n V yi a-r <br /> Lar_ 'rile '_est. of v_eme s i7 a 56 AlL 11^ r+ra ar S c. <br /> (3) TYPE OF WORK (check): 84 — 104 Sar,? s' ^ ^?vcly <br /> New Well ff Deepening ❑ Reconditioning ❑ Destroying ❑ 10-1, — 140 r -r:^ 'f i(? ? Ql ,^.v <br /> If destruction,describe material and procedure in Item 11. 140 17—r ".o%..r ? '^ ° C 1� and <br /> d <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 1 r 1 _9 4 lc r i t`1 v C 1' <br /> Domestic �f Industrial ❑ Municipal ❑ Rotary ❑ 164 _ 196) <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable El 1 or — ? c.ar'! ° r.^t7Ci <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLE 1Z DOUBLE ❑ <br /> Gage Diameter <br /> From ho or of From To <br /> ft. ft. Diam. Wall Bore ft. ft. <br /> 1 „ ' 12 <br /> 12 12 condu to r T ,0e <br /> }5,,{� <br /> 'Size of shae or well ring:v:. X_ Size of¢ravel: <br /> ).,C,ib,mint Dut:F�eld <br /> (7) PERFORATIONS OR SCREEN: Water Cade Sec..13752 <br /> Type of pertoratiun or name of screen <br /> Perf. Rows <br /> From To per per Size <br /> fC. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: ��rr <br /> Was a aurfaee sanitary seal provided? Yes N No❑ To what depth _50 fr, <br /> Were anv strata sealed against pollution? Yes ❑ No:t If yes,note depth of strap <br /> 4om fc.to ft. <br /> From ft. to it. Work started --?P 19 P ,Completed -5—Pr-_5 I9 2 <br /> dechod of sealing Em re C e'.'i nt WELL DRILLER'S STATEMENT: <br /> ;9) WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> /� of my knowledge and belief. <br /> Depth at which water was first found, if known 120 ft. <br /> Standing level before perforating, if known fr. NAME John 'L Pan-rc Jr. <br /> canding level after perforating and developing ft. (Person,firm,or corporation) (Typed or printed) <br /> WELL TESTS: Address 11 ';1+ S , Van 311en <br /> r n r 20 <br /> lmp test made?' Yes C] r,, CL YNo ❑ if yes,6y whom? p 1�/11 �,� � 7�GO <br /> d: gal./min..with ft.drawdown after lies. [SIGNED] <br /> (Well Driller) <br /> 'emper Lure of water Was a chemical analysis made? Yes ❑ No ❑ <br /> Was electric log made of well? Yes C1No C] er��t If yes,attach copy License No. 1 rn rr7 <br /> 24 Dated -3-70 19?2 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> Plate D-Z <br />