Laserfiche WebLink
RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY W <br /> V �I <br /> ithDWR DEPARTMENT OF WATER RESOURCES NO. 119251 <br /> f Intent %, WATER WELL DRILLERS REPORT St ite NV ell 4ii <br /> i'enuit 1141, or Date 7fOther Well Wn <br /> I 1 OWNER V tme TP .� 4c- ' �G (l2) WELL LOG Ttital dclitli/�_! Depth+it c,m,pleted well,[ it <br /> � <br /> dd rt„ <br /> { 1 ,114- r tntn, it to It Formation (Describe b. ailor character size or material)- <br /> Zip �C� <br /> ,2) LOC TION OF WELL, (See ulst)lt A10M) <br /> xnih 7.V r-,%_,, a,e , Ow net s Well Number <br /> %ell address if different from above i <br /> r.innship Range Sectio <br /> utance frim cines roads railroads fences etc / <br /> (3) TYPE OF WORK ' <br /> New Well K Deepening ❑ <br /> nrc n(� <br /> LL Reennsenn ❑ - <br /> 7 Reconditioning C <br /> Honzontal Well ❑ <br /> Destruction 0 (Descnbe <br /> iv- $r`- destruction materials and - <br /> nrcedutes in Item 12) <br /> 4) PROPOSED USE - <br /> � J � 7•+t! 7� imesnc - �� <br /> rri¢ation ❑ <br /> Industrial ❑ <br /> Test Well 0 - <br /> Stock Cr <br /> Municipal © - <br /> WELL LOCATION SKETCH Other ❑ - <br /> iii EQUIPMENT (6) GRAVEL PACK - <br /> 'Rotar, Reverse ❑ YesX No ❑ Size <br /> Cth]e /❑ air ❑ Diameterof bore <br /> Other ❑ Bucket ❑ Packed fmm �� tuy 5 ft <br /> ' 7, C-%sING INSTALLED t8) PERFORATIONS <br /> Sleet ❑ Plastic or Co rete C Type of perforahna or size Of screen <br /> From TO Dta Gari Froth To slot'J <br /> ft Et m Wall ft ft. <br /> 9) WELL SEAL - <br /> L'<•ai surface sanitary aeil pnivideO les No ❑' it vei to depth ft — <br /> Were strata sealed igZtnst pollution' Yes C] 10 u Intenah $_ft <br /> Vlethiid of ualtn• /t1 Y st in 15 Compfct 19 <br /> ' (10) W kTER LEVELS WELL DRILLERS ST kTE\1E\T <br /> Depth of first water if kntm ft This lneii tcas drdied under r8y prrisdiel rid rhieparr A true t„ !hc bent v? ret <br /> �r It knotcledgi. and <br /> Standing level after well coinpletw �-516 <br /> S1G\ED <br /> / 11 t WELL TF,STS r (Weil nl r? <br /> ' ��as well tes4 oracle, _ siir Q4r. It yes by whum'T �+i��fll <br /> x +f telt s Pump ❑ • Bailer J fir lift ❑ N,-\mE-A-jkq- Chess Well <br /> h to writer cif; start of test /ft kt end of tesL��ft (Person firm or corporation) (T)Pod or panted) <br /> Addrcsr_� <br /> ' ours W iter tem entice 95632 <br /> ischarae gal nun tfterai P Q �8 zip <br /> a if res by whom City <br /> ul agafysia ni4rle Yee q \t{ ]_ ,�g890$ Date of this repur <br /> lec me log m'tde, Yes {] �Co If +es attich to at this report License 'V�r� <br /> pwR te9 trite 7 701 IF ADDITIONAL_ SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />