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v �a ORIGINAL iTgTfi OFC 1LIF0RNIA File with j)WR THE RESOURCES AGENCY Do not rr(I in DEPARTMENT OF WATER RESOURCES NO. 232198 hie"('°`eO`"° WATER WELL r,PJLLERS REPORT 1 Local "w"'No.or Date • state well 1) Name OWNER: —� Other weu • �`.c- s Cdoresa_- ---� -'-'� i 12( L WELL LOC: Total dept} —ft.D�sth of rnmpleted we)t rt, 7114 b__� to ft. Formation (Describe by calor, !hancc4 tsize or materi►1) (2) LOCA,'rION OF WELLinstructions): p —� d & Q r a v e 1 (Sec instructioru); ' b r w n C l a y �^ well addrns —Owner's�1'e)1 Num Ser =_4 4 22 c l a y & r d y e 1 m i x e d �• if different from above 4 4 2 - 4 5 8 ' brown Gl.d Townshi, Y ---R'""e458 - 469 ' grave \ Dlstan -�—•----.Section — fT •n rrum cities.roads,railroads,fences.etc. 4 �t/b brown c ay ay w V—e—r7§rrF—eaTT- ----------- re 486 - 491 ra 1 ;v/cld strea <s 497 - 502 la wlgrave s rea�d s(3) TYPE OF WORK: 502 46 ,rave 'L New well u DenVening ❑ b4 `F 87 c ay s a e s rea s '— Reeorutructin° u 587 Reconditioning ❑ - gra-ve c ay d: Horizontal %4'ell ❑ ` - d 'j Destruction ❑ (Describe � .: destruction mate ials gra. _ -- IT Pro.edures in Item !yy - g r-ev (4) PROPOS CD � C d y Domestic d `C' . (rrigannn�� ❑ \ J` `.. ray h-� w'. industrial ❑ f84'. -:689 ' c_l a y\\&yg r ave m j x ❑ -\689>`- 705 ":7set grave son 'z Str.ck\� 1, '\',Z,0 5 - 7 2S c a-Y U tp,�9 r-a v e —c ay "'ELL LOCATION SKETCH Ocher (S) EQUIPMEN-r: �• D y c' f8) GRAVEL ACK: Rotary ❑ Reverse ((�� 8 1 8 9 ' ravel & C l a ❑ Q No Size:_ Cable ❑ Air ❑ �`,`r�\�,-,,,,l«\er nr bort <;; .8-9 2``8 9 4 ' gravel & sand Other ❑ Bucket ❑ raf,edJ"m —7, �8 9.4) - 9 0 2 ' hard c 1 a y --i"\ gravel mix (7) CASING INSTALLED. ^\\ (g)`).cRFJRA7fO,NS: �� .. 907 - 913 hard cla Steel ❑ Plastic ❑ Cont rete\l Type .1 perfnrnion it 1!!.r of acreen�^t 913 - 921 ' set sand & small ravel From tl Dia. Ca all Ftntil `-�) Slot 9 21 - 925 ' c 1 d & Q r P V e 1 S.t t e a k s fL fel �in. Wall (( •\ ' ft. �V . �• �� ' ;S`Z�' 9 5 - 929 sand & _small gravel 929 - 938sand & gravel X38 - 940 ' Cla (s) WELL SEAL: - 940 - 947 ' gravel & clay streaks Was surface sanity I 9 4 7 - 952 ' hard s h a l e & clay sanitary seal provided? Yes ❑ No _ 1f yes, to depth ft. 952 - 9 5 5 ' rave 1 Were strata sealed against pollution? 1-es Method of sealing ❑ " ` ' "` ft. 955 - 962 ' hard sha e c ay strea s -- wmk atzned _15_ m Copleted _ (10) WATER LEVELS: WELL DRILLER'S STATEMENT; Depth of first water, if known— It Stsrrding level after well completion Thit knit:w,11r as dbrlyd.under my iti—dictian and this rtynrt is frit to the best of my 1t f (11) WELL TESTS: Was well test made? Yes ^ Noyes, by P^ $IGNEU_ IF whnrn? Tyne of test Pump ❑ Bailer❑ Air hit U (ttell Driller) - Depth to water at star: of test h. At end of test_ ft N.AME__ f Person,titin,nr corwrtation) (Typed n,punted) DiscSasye ^altrnan atter yours N'a:er tem Addrosa temperature Chemical analysis rude? yes No tj !f ye., by whom? _� Gry• Was eleetrio Inc made? Pea [) Nn �, If se Hach c 'p- p t th r t r ) cev e\ _Date of the reta,rt DwR ted tiety.7.76i IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSEC JTIVELY NUMBERED FORM