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It STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not fill :n <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT NO. 298956 <br /> we"of Intent No !� � State Well No <br /> -26�� SgrJ #,7a,;4locol? ial1 ✓Is� t'y� Other Well No <br /> Local Permit No or Dale � <br /> (1) OWNER Name A IL CO (12) WELL LOG Total depth _.3 _ ft Completed depth- ft <br /> Address 30K from ft to ft Formation(Describe by color character size or material) <br /> City OQ/ + CA -- zip 9S2,10 — <br /> (2) LOCATION OF WELL (See Instructions) — 56E ATLACIZZ-bW- L G LO <br /> Count- .-1:5A q J0,d QU161 Owner s N%elL�67umber /y <br /> Well address if different from above / r t . C C1 — <br /> Township 2 -5 Range J ------- Section 9 E T <br /> Distance fro Ili ctGes roads railroads fences,etc / E w/a� _ f <br /> �f CQeMER QC /Al ERSC-4--T/OSI <br /> (3) TYPE OF WORK <br /> New Well 09 Deepening ❑ ` <br /> S,�E Reconstruction ❑ <br /> Reconditioning ❑ , <br /> 1 o e,q- 1tol-I n hP f{ortzontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures In Item 12) — <br /> (4) PROPOSED USE _ <br /> Domestic ❑ — _ <br /> Irrigation ❑ <br /> i <br /> Industrial ❑ _ <br /> Test Well ❑ — <br /> Municipal ❑ — <br /> Other 1Y0I(117"p!2/A/G 09 <br /> WELL LOCATION SKETCH (Describe) _ <br /> (5) EQUIPMENT (6) GRAVEL PACK <br /> Rotary W RUGEe Revere © Yes P0 No ❑ Size r <br /> Cable ❑ Air © Diameter of bored ` <br /> Other ❑ Bucket ❑ Packed from to .30 ft <br /> (7) CASING INSTALLED (8) PERFORATIONS _ <br /> Steel ❑ Plastic II9ricnete ❑ Type of perforation or size of screen — <br /> From TO Gage oTo Slot <br /> r From <br /> It It to Wall ft_ ft size — <br /> .�O i K IN <br /> (9) WELL SEAL - <br /> Wassurfacesanitaryscalprovided? les lR No ❑ If yes to depth 3.5 ft — <br /> Werestrata scaled against pollutions Yes ❑ No 14 Interval It — <br /> Method of sealing i J agooz�o F7 Ai rom T Wort,started 19 [ompleted ZZ Z4 I9 <br /> (10) WATER LEVELS WELL DRILL R'S STATEMENT <br /> Depth of first water if known 13 ft <br /> Standing level after well completion �3Z ft best ofimlt k_nt drilled <br /> ledg and bel of Iurecdtetlan and this report t5 tru[' to the <br /> WELL TESTS Signed _tea, _. <br /> Was well test made? Yrs ❑ No ® If yea,by whom? I ( IIDDr llcr) <br /> Fof test Pump ❑ Bader Q Air bfi ❑ NAMF' Gr r.1 w ft C h C <br /> hto water at start of test ft At end of test It 40 (Person f inn or corporahnn) or printed) <br /> istharge gal/min after hours Water temperature Address <br /> Chemical analysis made? Yes 9 No ❑ If yes b?whom? City Con orr� 4 cA- _`Lip 0 <br /> Was electne log made Yes C1No o If yes,attach copy to this report *9f[cense No ,y YJ D itt of flus repor! 7/11,18-7 <br /> DWR 186 (REV ta-ee) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 86 %ass <br />