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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMENT OF WATER RESOURCES �. <br /> WATER WELL DRILLERS REPORT N0. 2 9 8 9 S s <br /> 6"of Intent No 11 Stale Well No <br /> Local Permit No or Date S / .SJL#Z)> Other Well No <br /> (1) OWNER Name eA O Q!L Co (12) WELL LOG Total dcpth2 -5 ft Completed depth 25 ft <br /> Address P 92, .90X 120 from ft to ft Formation (Describe b} color character size or material) <br /> City 02>i�, CA zip 9SZ40 _ <br /> (2) LOCAJION OF WELL (See instructions) - 50E AT7-ACtLjEb iF4Z LO G <br /> Counts J_AN tOA V1/1l_ Owner s Well Number <br /> MAI- <br /> Well address if different from above15-371,46_ � C / — <br /> _ <br /> Township %5 Range %5 <br /> t Section <br /> Distance from cities, roads railroads, fences etc 51 £ — <br /> w/ 0&YjF S.5 TA7-/ - <br /> F JAILER—SEC C./ T+rI 'IF- t — _ f <br /> (3) TYPE OF WORK <br /> New Well K Deepening ❑ — <br /> Reconstruction L1 <br /> Reconditioning ❑ <br /> 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 /> Municipal ❑ <br /> Other 1 OM17bRiA(0 R _ <br /> WELL LOCATION SKETCH (Describe) _ <br /> (5) EQUIPMENT (6) GRAVEL PACK <br /> (f(�"+� <br /> Rotary 0 An Reverse ❑ Yes V No ❑ size <br /> Cable ❑ Air ❑ Diameter of bore + �' <br /> Other El Bucket El Packed from,4 to It <br /> (7) CASING INSTALLED (8) PERFORATIONS <br /> Steel ❑ Plastic Of Concrete U Type of perforation or size of screen _ <br /> From To l Dia Gage or ^ From To Slot <br /> It It in Wall ft ft size <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes lel No ❑ If yes to depth ft <br /> Were strata sealed against pollution? I es ❑ No ❑ Interval ft — <br /> Method of sealing ;::rU J' /�& F \'fort.started — 19XZ Completed � iqML <br /> (14) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if known 12' '7 It <br /> 2.�1 LCGe� �` ft Zhis wrI! to drifted and iV lur:sdtctiart and this report is trot to t1u <br /> standmgleselafterwellcompletion bewo my n wledgean fx <br /> (11) WELL TESTS <br /> Was wt 11 test made? Sus r igned <br /> ❑ No� If yrs by whom (1►tl]Dnllr <br /> Wof test Pump C1Bailer El Mr hit ElNAME <br /> h to water at start of lest ft At end of tr%I R 01 (Person fimi or corpo nit)(Typed or printed) <br /> Discharge gal/mm after hours Watt r temperature Addrt sti �/ <br /> ChtmicalanalysismadO Yes a No ElIfvss.hywhom? rr0M Ots ! ls1Sr6[[/ CA <br /> Was electric log made Yes ❑ No If yes,attach copy to Ihis report License Na j l`4go a o2 Date of this rt port 06' 0IF7 <br /> DWR 100 (REV t2-88) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM ae V63S5 <br />