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QUADRUPLICATE STATE OF CALIFORNIA <br /> Do not fill in <br /> Use ofcomply with THE RESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 173124 <br /> Intent N,,. WATER WELL DRILLERS REPORT state Well Nr. <br /> I,mal Permit No. or Date 85-414 OOthh¢er Well No. <br /> ) 1) OWNER: Name Pa in Plant (12) WELL LOG: Toed depth425_f. Depth of completed welL3,90ft. <br /> Address from ft, to k. Fummtion (Describe by colo, character, siE, or material) <br /> Cl Stark nn, Ca zip - <br /> (2) LOCATION OF WELL (See instructions): - 5 R a <br /> County SAO JnAg0n Owners Well Number <br /> Nk ell address if different form above <br /> Township Range Sectio 39 - 43 Sand <br /> Distance from cities, mads, railroads, fences, etc. A I - <br /> 150- 154 Sant! <br /> 154- 174 clay <br /> (3) TYPEOF WORK: - <br /> 1q7 rlavR <br /> New Well N Deepening ❑ 1117- ZQ I Sanii <br /> Recurotclactio <br /> - <br /> Recnmtraction ❑ 261 - 241 (.1 a y <br /> Reconditioning ❑ f <br /> ana <br /> Harizontal Well 211.9- ry71 Clay <br /> Destruction ❑ (Describe '.1- <br /> destruction materials and <br /> 97P SAnd <br /> procedures in It. 12) 272- r <br /> (4) PROPOSED USE: 795 Sand <br /> - <br /> Domestic k - 360 Clay <br /> Irrigation ❑ - 364 Sand <br /> Industrial ❑ 4- 370 Clay <br /> Test Well ❑ <br /> Stawk ❑ 37F- 380 Clay <br /> mumici, <br /> - <br /> Municipal ❑ <br /> 380- 367 san� <br /> WELL LOCATION SKETCH I Other ❑ - i• <br /> (5) EQUIPMENT: (8) GRAVEL PACK: Gravel &t <br /> Rotary Ix Reverse ❑ Yes ly. No ❑ Size_ Sanid - - <br /> Cable ❑ Air ❑ Diivueter of bore 2 1 <br /> Other ❑ Bucket C Packed from tr_. 39O 1, - 1�y <br /> (7) CASING INSTALLED: (8) PERFORATIONS: - <br /> Steel 1p Plastic ❑ Concrete 2 Type of perforation or size of screen - 19 <br /> 65 <br /> From To Dia. Cage or From To Slot - <br /> ft. ft. in _. Wall ft. ft. size - U L!, I AL HEALTH <br /> 0 190 lo! 211q C0 Stnndar <br /> - <br /> (9) WELL SEAL: <br /> W. surface sanitary seal provided? Yes Ki No ❑ If yes, to depth 50 <br /> Were strata sealed against pollution? Yes ❑ No ❑ late,.] ft. - <br /> Method of sealin Work started APIR 2r� 19 Complat d 19 <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth of fiat water, if known ft. This suet) axis drilled under my jurisdiction and this report is true to the best of my <br /> Standing level after well completion ft. knota/edge and belie/. <br /> (11) WELL TESTS: Stoxen <br /> Was well test made? Yes ❑ No fol If yes, by whom? (Well Driller) <br /> Type of test Pump <br /> El Bailer ❑ Air lift ❑ NAME <br /> Depth to water at start of teat ft At end of test ft ( eu-M?corporaciun) (Typed ;!printed) <br /> Discharge cal/min after bouts Water temperature Address 359; D F I A U D E 1 F A V E C <br /> Chemical analysis made? Yes ❑ No If yes, by whom? City ff 0(j F CTIi, C A ZfP 913 56 <br /> Was electric Ing made? Yes ❑ No If res, attach copy to this report License No, Date of this repo <br /> DWR 188 (REV. 7.7e', IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />