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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES l��I <br /> O 91338/ <br /> File with DWR " -- 7" <br /> WATER WELL'bRILLERS REPORT State Well No <br /> Other Well No. <br /> (1) OWNER: (11) WELL LOG: ,l <br /> Name T E 1 1P rTotal depth it. Drpth of completed well L ft. <br /> Address / l9 Furmarion: Drrcribr by robe,rber¢or,riss p)material,tete¢Ilnofare <br /> j'ti ft.so ft. <br /> (2) LO ATI OF WELL: U U <br /> ,,s2', J'A Owver's nmober,if any 11. <br /> Township,Range.and Secrion 1 <br /> vvc 7, <br /> D'sa a fm Dads, allroads,sor. u <br /> (3) TYPE OF WORK (check): <br /> New Well tv' Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destruction,describe material and procedure in Item 11. Re <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic Industrial E] Municipal ❑ Rotary ❑ i On <br /> Irrigation P Test Well ❑ Other ❑ Cable — <br /> Other ❑ — 1010 _ <br /> (6) CASING INSTALLED: _ ~ <br /> STEEL: OTHER: If gravel packed A $- <br /> SINGLE �DOUBLE l] p A r <br /> Gage Diameter JIV <br /> From '1'D or of From To Zojd <br /> ft. ft. Dia.. Wall Bore ft. ft. <br /> �f <br /> Z /Z <br /> Sa of shoe well ring: Y. S'z of¢surf: <br /> Describe iomtY/A/w1 <br /> (7) PERFORATIONS OR SCREEN: Tt,Tt <br /> Type o[cerforuiun a of a <br /> Pert. Rows <br /> Fro. To per per Size sl- <br /> ft. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Was v surface sanitary zeal provided? Yes�No O To wM1M dept ft. <br /> Wae any xuu sevled agdnn pollution? Yes❑ No @r� if yes,note depth of strata <br /> trvm <br /> f,.,. is. Work sorvd 19 ,Complexed — Ip <br /> MaM1nd of warns WELL DRILLER'S STATEMENT: <br /> 9 WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> ( ) of my knowledge and belief. <br /> Depth at which wue vas five found, if known f. / aqss p / - <br /> Susolm, Intl beforer perforating, if known ft. NAME ! /1 L— i <br /> Snndin level after perforarm and develo ins ft. 14 0 <br /> (Person,firm, r corporins.) (Typed or pri hd) <br /> (10) WELL TESTS: Address'J j—/ e !�� <br /> Was pump rest made? Yes ❑ No p If yes,by whom? 1't <br /> Yield: ¢sl./oo—with ft.drawdown after her. [SIGNED] <br /> Te n......r of water, WAS a Chem of aalysis made? Yn El No L1 (Well D�rijlls) �Jl <br /> Was electric loa made of welD Yes ❑ Na Da nIf yea,amcM1<ovy License NA, D ✓�Damd� <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 1 REe. p-Eel ael]9-pes p-ea se.T¢,e h,D ose <br />