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/ 4 <br /> ���jl�K�+ 4 9TATM OF CALIFORNIA Do not fill 441 <br /> THE RESOURCES AGENCY O <br /> p!© with DWR DEPARTMENT OF WATER RESOURCES No. 6 <br /> ce of In63 <br /> tent No WATER WELL DRILLERS REPORT State Nell No r1 —=- <br /> OWNER. <br /> til Permit No or nate 0 Ivo r1 - (C f I.- <br /> y Other Na q �� <br /> {I) OWNER, N.meC H 2 M H 1 1 1 1 (12) WELL LOG Total dopthj_2-L,^ft Depth of completed well.1 0 ft <br /> ,Address 2200 Powe11 St from it to ft Formation (Desenbe by color, t hancter. size or makartnD <br /> CIty W Emer v111 e CA Zip 94'08 0 - 23 BrQwn sandy clay <br /> (2) LOCATION OF WELL (See instructions) 23 — 32 Sand <br /> County Owooes NVen Number 32 - 40 S1 It Cl a <br /> Well eddress If different from abnv. 40 - 55 S a n d , <br /> Township 1 N ,ntie6 E sectio 6 5 6 2 SiT ty & NQ zry <br /> DLtanvo farm clues roads ratlm-as,fences etc 62 - 4 St <br /> 74 12 S1'l, � &, ay <br /> San' 1 <br /> I (3) 1YPE OF WORK �l <br /> Now Well a Di-epenmg Cl <br /> Reconstruction 0 <br /> Reconditioning 0 - C-,,. N/ <br /> Horizontal Well 0 <br /> e e map attached Destruction 0 (Describe (� <br /> destruction muttrtals urt}I <br /> ,procedures In Item 144 ,: <br /> (4) PROPOSED U; fy r i <br /> IDomestic <br /> Irriganen k 0 <br /> Industria] <br /> I Ties X <br /> 5at.k <br /> MunloIpa] ~ ❑ <br /> WELL LOCATION SKETCH Pther <br /> (5) }QUIPI+IENTr (8) GRAVEi1'ACK `.� � <br /> Rotary ( ( Reverse [i ,Ye�s� No ❑'� Sii 2 lC tel' <br /> Cable 0 Air 0 ~U�larT$ f bo Z — <br /> I Other 0 Bucket ❑ Palk from � tom! -- <br /> (7) CA3SNG INSTALLED i �� fe) PEAFOAAT+I`dt <br /> Steal 0 Plastic ❑ Concrete,(] rype of pert'Di oft or su of screen <br /> o �}1 - <br /> , '.�o <. _ <br /> krom To LZia Gag� r o <br /> Fra . <br /> Ft ft L `rn Weill ft ft -< \St74 <br /> a 12 •��, 6 s 250 <br /> 110 — <br /> (9) WELL SEAL <br /> 1Was surface sanitary seal provided? Yes ❑( No f3 If yes, 10 depll>_].J-5 ft <br /> I Were strata sealed against pollution? Yes ❑ No ❑ Interval ft - .. _ _ <br /> hfethod of realmic G Work starte 1B Com lets 1.9 <br /> (10) 'WATER LEVELS --;_-" , WILL DRTLLER'S STATEMENT <br /> Depth of Gist water If knawn. tr This welt wits r led lender my rttrfsdeclran apd this report is Arne to the best Of 1%,I Standmg level ufter well complodo_ M- 1 ft knowledge o elle( <br /> (11) WELL TESTS t Slc ren <br /> Was well test made? Yes i7 No M If yes by wh4mi <br />