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STATE OF CALIFORNIA Do Not F111 In OR1GIMAL THE RESOURCES AGENCY File wath DWit DEPARTMENT OF WATER RESOURCES �\ �J ? 147186 WATER WELL DRILLERS REPORT state Well No IIJ M Other Well NoLk5zz G (I) OWNER LOG This well wai drilled under my jurisdiction and this report is true to for best Total devtn . r „ ^- Name Gage Diameter Address ! u or of Fram ft it Dram (2) - LOCATION OF WELL $ort ft L Lou r t .a<s- � �'_ -- _ b_ v number if ane -C Tevns(sep Range and seeuon ... t— ., .` -y ^ q--- == Usss mei from Haas rosdt ratlrtuds etc - - " " r �; �^ tell erne r- _ _ Su at envel (3) TYPE OF WORK (check) �� 7 Ye.ld aal lmsp wish New Well_L]Deepening Reconditioning ❑ Destroying Trp. til lienor, rtunv ofs ' If destruction describe material and procedure to Item I 1 madei Yrs C3 No (4) PROPOSED USE (check) (5) EQUIPMENT Domestic ❑ industrial ❑ Muructpal ❑ Rotary ❑ Irrigation � Test Well ❑ Other ❑ Cable] f Other ❑ (6) CASING INSTALLED STCEL OTHER If gravel packed SINGLE a DOUBLE.M (S) CONSTRUCTION Wa a urlaee saaeta" teal pro,, deda Yn [] %o (� Wer seafad ]a. -r \o L from fe To ft To ft Size in x In To «hat depth ft If vis note dtotb of orae. 11) WELL LOG This well wai drilled under my jurisdiction and this report is true to for best Total devtn . r „ ^- ft Dev6 of comvletad —P .. Is Gage Diameter Froin ! u or of Fram ft it Dram Wall $ort ft L :.. .ra... �.,.. -C - 1i u TT`L-� q--- == Ssz til shoe ,, Address J J . tell erne r- _ _ Su at envel Ue.c r, bei nt �� 7 Ye.ld aal lmsp wish (7) PERFORATIONS OR SCREEN Trp. til lienor, rtunv ofs Temperasurr of waxer War s ch—.1—Ns., madei Yrs C3 No PCYI Rpws If ve: atvri, r... From To per per f ft row ft (S) CONSTRUCTION Wa a urlaee saaeta" teal pro,, deda Yn [] %o (� Wer seafad ]a. -r \o L from fe To ft To ft Size in x In To «hat depth ft If vis note dtotb of orae. 11) WELL LOG This well wai drilled under my jurisdiction and this report is true to for best Total devtn . r „ ^- ft Dev6 of comvletad —P .. Is Formation Derrrrbr by rolor ehererter tris of metertrf —d rerureure ft m ft f[ NAME _ v — L :.. .ra... �.,.. -C - 1i u TT`L-� q--- == Address J J . W u vumo teat made? Yet ❑ No 0 ]f res 6r -Kam? -^. � �. r' _`� i ' a t � � — • / J r r- -- Ye.ld aal lmsp wish ft drawdown afro hes (SIGNED] 1 Temperasurr of waxer War s ch—.1—Ns., madei Yrs C3 No I Will Dnflrrt Wu elecerse Ip[ made of wefts E Yes 17 No If ve: atvri, r... r _____ ,.r_ ....� I ^s" _ _ n_._a �~ ... ( 7 Frim f[ to h Work scarred 1 L 39 ( i Compla[ed �-"' 4~' t9 J ueihod of .ealme WELL DRILLER S STATEMENT (9) WATER LEVELS This well wai drilled under my jurisdiction and this report is true to for best . ! of my knowledge and belief Urpsh at «b,ch eater ear first found if known �'T fe litandme iced before perforate.; tf known f[ NAME _ sundentr Incl after perforati.e end dr,efoosne It (Prraors firm or corporation) IT)prd or prtntrd) (I0) WELL TESTS 1i u TT`L-� q--- == Address J J . W u vumo teat made? Yet ❑ No 0 ]f res 6r -Kam? -^. � �. r' _`� i ' a t � � — • / J r r- -- Ye.ld aal lmsp wish ft drawdown afro hes (SIGNED] 1 Temperasurr of waxer War s ch—.1—Ns., madei Yrs C3 No I Will Dnflrrt Wu elecerse Ip[ made of wefts E Yes 17 No If ve: atvri, r... r _____ ,.r_ ....� I ^s" _ _ n_._a �~ ... ( 7 SKETCH LOCATION OF WELL ON REVERSE SIDE I DWR 188 eREv 9 as, 4 ,_72 304 TRIP(Dr osp