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ORIGINAL WATER WELL DRILLERS REPORT na Not tit 7n <br /> F110 with ow;t (Seattoas 7079,7010,Taal,roar,tivater code) <br /> I <br /> e � � THE RESOURCES AGENCY OF CALIFORNIA N9 44228 <br /> �� LVxs Jo. '190 DEPARTMENT WrII rIo-) <br /> DEPARTMlrNI" DF WATER RESOURCES Oodo ocher Well No. <br /> (1) OWNER (11) WELL LOG,- <br /> Name <br /> OG;Name <br /> TBsal death t1 ft Depth of completed well !J rr <br /> Address <br /> Forms none J)","be by color chararir r,Bre of moleshi,Bed srrrrlerr <br /> (2) L AxION OF ELL rr ra ft <br /> CevatY [ r Owner s numher f Z.y <br /> Towarh-p Eragr an 5en,or <br /> nlrlanee front rtuts rorde,mlraads era r <br /> (3) TYPL OF WORK (cbeck)• y <br /> New W1 0( Deepening [3 Reconditioning C] Destroying [� <br /> 11 desrnrelion,describe ma(erral and Procedure rn Hern 11 <br /> (4) PROPOSED USE (check) (S) EQUIPMENT. <br /> Domestic [ Industrial El Municipal Rotary r. <br /> Irrigation 0 Test Well[3 Other Czble <br /> Other <br /> 1 (6) CASING INSTALLED: <br /> STEEL OTHERt If gravel packed <br /> SINGLE DOUBLE Q <br /> Gage Diameter <br /> Frain To or of From To <br /> it it Dlam Wx1i Bore ft it <br />� ITS <br /> ' <br /> S,ae of shoo Br well thne ') I Sae of ravel <br /> Oescnbe Jurat- Z <br /> (7) PERFORA I'TONS OR SCREEN- <br /> T ps of iwfontron or came of sceeen <br /> Per£ Rows <br /> firom To per per Size <br /> fa fe row ft en x in <br /> I <br /> (8) CONSTRUCTION: <br /> Wae a Outface seances IPI provided) Ye 0 No CK To ghat depth ft <br /> Were any strata sealed aXmascI{1lanoe) Yes No 0 If yrs Bora d. t1t of rtrara r <br /> Fmm !t to []� ft <br /> From ft m ft Work starred y•-,a 19 completed <br /> Jj ]9 <br /> I Method of ual,alt - WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS: f This well war drilled under ray lurrsdrctmn and this report a true to the best <br /> t MPA at vbech water vas HBc found tf faowa o/Pay knmuledge and Belk} <br /> i fs <br /> ISunda* tele) before perfotan., rfknave ft NAMZ O <br /> s Stand,alt level after 091f0ftt1off sed darelooia ft (Ftnon,firm,or corp0raltoo) (T ed or prierrd) <br />• (lo) WELL TESTS. Address a9 a <br /> 1Pato roc sande? Yes ❑ bfo❑ If yes by whom? <br /> o -- <br /> d oaf fmia with fr dtawdowo after <br /> �rw <br /> Temperacuu of water Was a eltcnoteal anal ser made? Yes❑ No © (Well Dr! ref <br /> War deccne log made of veil) Yet ❑ Ne I� IF yes attach ro y1 �� /"/r""- f <br /> License No <br /> SKETCH LOCAT'1ON OF WELL O(4 REVERSE SipF <br /> I <br /> 119301490 40 69 sax TRIP A oai <br />