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r � <br /> STATE OP CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not 1"1 in <br /> I'Ve %vifE. ':,'VP DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 257287 <br /> Notice oft -N. o._ State Well Yo. <br /> Ener. Ptrmit Na or C::te 2F-2-5--7 6 Other Well No, p' <br /> OWN R: Nnme CH Ev Old 054 I�tlG• (I2) WELL LOC: Total depth 2� it.Completed depth I7 'ft''"S <br /> A.-,J- 2 AO ^ k )N O �E �' from Ft to ft Formation(Describe fry.:Aw.character,size or trtiterfal) <br /> City •S4 4 O _—ZIP 9 _ O. rev : <br /> (2) LO�CAAT^ ON OF WELj (See instructions): Ci= 5 c ' 1"-e- <br /> county .Q I M Owner's Well Number w t Gl �(t 4t,t t t.►o `� <br /> Well address if different from• ve 2. Kl1SJeN 92. SANTA G} `k lcsw VQ" <br /> Township <br /> -1-2-S Rando O - <br /> � ` `ts {°fit ' - " ° ° 1N <br /> Distance frgm cities,roadsrailroads,fe ISO' <br /> N si � S<ZL— <br /> �r�tH �✓ 1 -.� - l 5i 5 t 4AIIA <br /> 2 .'S <br /> (9) TYPE OF WORK: - �>>dr f Pit <br /> r New Well X Deepening ❑ <br /> U i MW�� Reconstruction ❑ <br /> `O Reconditioning ❑ <br /> Horizontal Well ❑ _ ✓sc� k ` <br /> Destruction ❑ (Describe i x <br /> F1 r=L "f 1r2/s lugdestruction materials and pro- <br /> L , ;C •ret , <br /> cedures in Item 12) <br /> (4) PROPOSED US _ •:...zs<�i�r �s( <br /> S ' Domestic _ x.,:ttidVEfvtSkt�� <br /> gation <br /> t. Industrial ❑ _ ri•'1i mr..,t' <br /> Tut Well O ❑ CXo- <br /> P Munici ❑ _ "` <br /> er <br /> WELL LOCATION SCETCH be) - Ni s F: r <br /> (ti).EQUIPMENT CRAY CIL <br /> Rotary ❑ Reverie ❑ <br /> '. Coble..❑ Ale f1 of bore - .. _ ., .-•_ <br /> :tlf 4 <br /> mm �. — Zd r - +:lex�.A�•...�.. ,l_ ,v ' <br /> (7)CASING INSTALLED (g) P TI Q _ _ ;�;. r J•' ". <br /> SteeF❑. INanie • Ty e or Sim of <br /> r <br /> From D' Cageor <br /> ft.` f Wall t size <br /> &4641 3 0175 <br /> .(9),WELL SEAL <br /> Wu surfacenMtM seal provided?/ Y.�' No❑ If yes,to depth ft <br /> Werestrahseafed plryt utlen Yes ❑ No[7• Interval fL <br /> CRt"Gk vu <br /> IrI d d of sealing�oew%.'1v r Work started O 19 Com let 19 r 4r <br /> (10) WATER LEVELS: - WELL DRILLER'S STATEMENT <br /> Depth of first water.If known <br /> fL ` s r <br /> This well was drilled undar m JuQietfon en t report rue,to t <br /> mand <br /> l.� ^ <br /> Standing level after well copo"-r2 7 ea� o rAa! `) ft hest of my knowledge andbalief. ✓ <br /> 11 WELL TESTS. <br /> ( ) E�- ENS. ���Signed <br /> Wu well test made? Yes No❑ If ya,b horn? S P�G T Q u ti, K XP Liter) O� w 1 r Y <br /> Type of:est :.:. Puma'n Bailer Air uft ❑ NAME r ,V '- <br /> "' pptlt <br /> to t n of ed ' <br /> ft. At and of test fl. �pee�t�f )(Types printed) kA t* t c <br /> i a) Address <br /> b�1 5 tom• RUCs 5 T <br /> Dlselurie gal/mina(tar Noun Wat•r}gr�prntun STSG�rd N �2os <br /> Cheml.alaralysls made? Yes k No❑ If yes•by whotns 1- City ZIP <br /> Was electric log made Yes ❑ No If yes.attachcopy to this report Lice.N. ✓�(� Date of this reportfC Zy <br /> IF A150MONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> DVv11 lea MEV. ta-am -:N1 tWM <br /> ..��RwY�w����._� _ _ _..T�•._ .�_.�."`^"`r^�•a.wauor•+�R.+n•+-`;--� - ..��. ..�_,. _. _.�'_'.Nr'�VBL�r ' .t: ;,.. J�Yj <br /> -61 <br /> .. .1r..3,..Y;i �• ^, .ac - to <br /> t'+,L1`� t <br /> - .. ... ..xis +;r3Ls F'.� <br />