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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY no not fill to <br /> 'Fele with DWR DEPARTMENT OF WATER RESOURCES _ r <br /> WATER WELL DRILLERS REPORT NO. 2 9 8 2 `_ 4 <br /> 0cr of Intent No State Well No <br /> —/z/ .s,)l A1pJ Other Well No Iffasn �+°l <br /> L.ncal Permit No or Dale '/ <br /> (1) OWNER Name A L Z <br /> (12) WELL LOG Total depth ft Completed depth _ft <br /> Address F X go from ft to ft Formation (Describe bti color character size or material) <br /> City - L O 8/ CSA ZIP 2 _ <br /> (2) LOCATION OF WELL (See 'Instructions) — tE' rACAl� LL L 9—<C- <br /> County <br /> County _-.rA-L J A LJ.1& Ow ner s Well Number � — <br /> Well address if different from above / E• / ! EeEZ4 _ AC — <br /> Township Is Range Section le <br /> Distance from cities roads railroads fences,etc IQ T <br /> QF AIW - <br /> C4kAgEje 0,0 r - / ,cl F r A/ r.$r - <br /> (3) TYPE OF WORK <br /> r� New Well 11 Deepening El <br /> v,67,F AT'TACN99D Reconstruction ❑ <br /> Reconditioning ❑ - <br /> -4/0 e,47/0 N Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) _ <br /> (4) PROPOSED USE _ <br /> Domestic ❑ _ <br /> Irrigation ❑ <br /> Industrial ❑ _ <br /> Test Well ❑ <br /> MuniCtpal ❑ _ <br /> Other NOAl ra AING 54 <br /> WELL LOCATION SKETCH (Describe) _ <br /> (5) EQUIPMENT (6) GRAVEL PACK <br /> Rotary ®s9Q;CRRever-e ❑ Yes fig No ❑ Size <br /> Cable ❑ Air ❑ Diameter of bore C9 &y_C::.4 <br /> Other ❑ Bucket ❑ Packed from to lixt ft <br /> (7) CASING INSTALLED (8) PERFORATIONS — <br /> steel ❑ Plasttc �Z Concrete ❑ Type of perforation or size of screeu <br /> From To -Dia Cage or From To 'Slot — <br /> ft ft In Wall ft ft size — <br /> D 24' 6 OZ 1H - <br /> (9) WELL SEAL — <br /> Was surlace sanitary seal provided? les No ❑ If yes to depth ft <br /> Were strata sealcdagainst pollution? les ❑ No ❑ Interval ft — <br /> Method of sealing T Tf Work started 19 Completed 19 <br /> (10) WATER LEVELS q WELL DRILLERS STATEMENT <br /> Depth of first water if known • ft <br /> Standing livelafterwellcom comple1:4tion This wc!l i t drilled un r my 1urndtclion and lhes report is lrur to the <br /> g p l g w ft . iowfedge d lief <br /> (11) WELL TESTS ed <br /> Was well Ist madr? ]es ❑ No ® if yes by whom+ (v1 X11 D r) <br /> of t-1 Pump ❑ Railer ❑ Air lift ❑ NAME y T� / <br /> th to M ager at start of test fl At end of less ft (Person firm or rnrpurauon (Typed or printed) <br /> Discharge Fal/moi after hours Water tempi rat ure Address p <br /> Chemical anal)sis made Yes$d Nurg— If yes,by whom? ",;e, Mt City 7 7IP 7 <br /> Was electric log made l es ❑ No 19 If yes attach copy to this ri port Vis License No Q Datc of this rc port • 7 <br /> DWR 188 IREv 12-861 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORUM 86 96355 <br />