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4.4 e _ <br /> l4iGINA! a STATE OF CALIFORNIA Do not fill m, <br /> 4olt3 with riwR THE RESOU RCE~S AGENCY No. 216036 <br /> DEPARTMENT OF WATER RESOURCES <br /> "Pf Iptent No WATER WELL DRILLERS REPORT State well No j t <br /> ur-erralt No or Date Other Well No-0--o r 0(11"x"'� <br /> (i) OWNER, Name mcca 1. ck�7& Baxt Y (12) WELL LOG. Total dapth ]_.$3 ft Depth of completed tiveI x70 Fr <br />' Address Bc�X r.� _ __ _ from ft to ft formation (Desenbe by calor character size or mntenal) <br /> citySton � C'� zip9�?nl_� 0 23 Brown sandy cls <br /> - <br /> (2) L� �F� (See tnstntchon23 32 Sands) d SW 4d 32 — 40 Silt & C-la <br />' CDunty 0avrter s Wr,ll Number r <br /> 1Yc11 address!f d,lfeten[from nbovu 40 55 Sand <br /> 51) 6 2 siltffat <br /> Township Range^� KF Seetlott____.___. ^ & T,/� <br /> D,31ance from aides road,,rallmad, lenses etc <br /> - ail ~.^i ay <br /> (3) TYPE OF WORK 2�A <br /> New Well N Deepening ❑ <br /> .�l,■■11 t� �v <br /> !' Afl 13ccon,true tlen <br /> Sec-gyp attached Reconditioning ❑ � � <br /> 13onzontal Well ❑ yF��-� ^ <br /> Destniction ❑ (Describe <br /> destruction matorinls ands <br /> procedures in Item <br /> dw <br /> (4) PROPOSED SE'./ 4,, _ <br /> Domestic !z� � !f /'� <br /> [rriRetion ! ❑ <br /> Industrial <br /> Tef,RWell <br /> I WELT. LOCAFION SKrTC1I <br /> (5) TdQIJIPMENT (0) GItAVELa`P CKt 2 f��i' RO",,b �j <br /> Rotary IS Reverse ❑ YaNo `�'' <br /> Cable Cl Air ❑ , p�ln�oya`of bore_ <br /> Cather ❑ Bucket ❑ ra fid tali <br /> (7) CASING INSTALLED �4 (&) IPRFOUATI <br /> Steallk Plastic 1t- Cnn retq Typo of parte rytry lgll or siie of screen L ^ <br /> f From To ;'l?la I Caja be Fra `r�.iTo �l�k,Of <br /> ft ft k1, `tn Wall ft1 Z It <br /> \� PA <br /> 0 178,'6 8 168 " <br /> (9) WELL SEAL <br /> Was surface snnftery seat provided? Yes ($ No ❑ if ye,, to depth-_162--ft <br /> Ware strata sealed against pollution? Yes D No ❑ InterVal - ft - <br /> Method of saalin Work starte Irl Camplet Ila <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water. if knowit This roelI t niled under my rLr on and t i report is trrte to the best of nw <br /> Standing level after well complebo - t krtawledIIa belief `3 <br /> (11) WELL TESTS R. _ Stctr <br /> Was well test made? Yee (] Ne a I�yes, by -hr)-?- ell n 1 1 <br /> Type of test r ' Pump C) Defier❑ Air lift❑ NAME <br /> Depth to wnt�r,al start of test�....�..ft ' At end of test-ft <br /> (Persorri flan,or corpoxatlori) ( ped nr panted) <br /> ischargo� tvILt/pdn after hbuss 0 Water tempanture Address <br /> anical analysis made?i Yes Cl No If Yes by whom? Cfiy; Palo ❑ f`A Zip <br /> ar electric log made? Yes Ll lq)o If yPs, attach copy to this report Licema No Date of this repo <br /> InWR 188 ift4�7stint; IF ADCjlTIONALfSPACE 3S N54DED USE NEXT CONSECUTIVELY NUMIaERED FORM <br /> I ` <br />