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ORIGINAL WATER. WELL DRILLERS REPQRT Do Not PiII IS <br /> File with DWR (sections•7079,7080,7081,7082,'Water code) <br /> THE RESOURCES AGENCY OF CALIFORNIA �( <br /> ° 45'7fi9 <br /> `►.✓ ,;t.:e..f` l i,'af �,�L9 Stu*dl N }_ <br /> .0101aWater Code Sec. 15752 DEPARTMENT OF WATER RESOURCES <br /> qW Other Well No <br /> (1) OWNER.: (11) WELL LOG: <br /> Name Total depth ' fr. Depth of completed well it. <br /> Address y G Formadons Describe by color,Character,she of material tod:iructare <br /> . S�t <br /> ft.to fr. <br /> (2) LQPATION OF WELL: -7 <br /> CoantY 4.y,,Jt Owner's nnmher,if aaY <br /> Township.Rings, 8d S on 4C6 <br /> Distance from cities roads,railroads.eve. _ <br /> f) 911 <br /> (3) TYPE OF WORK (check): Q r <br /> New'Well Ed Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> I f destruction,describe material end Locedure in)tem U. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: L251,, a <br /> Domestic [3 Industrial ❑ Municipar•❑ Rotary ❑ -46,2– <br /> Irrigation ❑ Test Well❑ Other❑ Cable M 14 124? <br /> Other ,�t1�- e2.,� a tJ <br /> (6) CASING INSTALLED: <br /> STEELI OTHER: If gravel packed <br /> SINGLE❑ DOUBLE❑ <br /> Gage Diameter <br /> From 1'0 or of From To <br /> fr. ft. Diam. Wali Bore it. it. <br /> she of:1108 or well rings V ,t X, Size of aravelt <br /> Describe loin /'1{ p N•f!d4 <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perforation or name of screw <br /> Pelf. Rows <br /> From To per per Size <br /> it. ft. row ft. in.xin. <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes[I No 0 To what depth ft. <br /> Were aaY stns sealed spinet pollttiion? Yes❑ No❑ if rQJ6 note dapth of strata <br /> From ft.to .�. ft. t <br /> From -ft.to °�r.3 ft. Work started -3 19 ,Campleted <br /> Method of sazlia ; ;'^�' WELL DRILLER'S STATEMENT': <br /> (9) WA-'ER ILEVEItS. <br /> t This well tear drilled under my jurisdiction and ibis report fttrue to the best <br /> of my knowledge and belief. <br /> Depth at which vnte`t was lune FoaOd,if known ft. <br /> sundtng level hafo:a'jed..d ij known it. NAME f �JAIX -4 <br /> SundiOg loyal affir' :fent and levet n ft (Person,firm,or corporation) Pped or privre <br /> (10) VES t TESTS'— Add.49,/j ArIA 49217 <br /> omp test made? Yes O O if ,by wheat? <br /> Ital./min,with fc,drawdown sitar iue. <br /> Tem (Well Drifter) <br /> pr state of water Was a chemical analysis made? Yes C') No❑ <br /> M.M.ateetric log made of well? Yea Q No 13If yes,attach co License NoIl` Sly Dated /® 19_ <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE ��s,,..• A i <br /> .. 4 i <br /> ?fa c-, coil 1 Sao. 13752 <br /> DWR 188 'REV.9.8,S) 59392.99010_63 Soot TRIP 0 A oar <br />