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� 11 <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> &lis with DWR (snctaena 7079,soap,foal,softs.Watasr can.) <br /> THE RESOURCES AGENCY OF CALIFORNIA N� 26237 <br /> DEPARTMENT OF WATER RESOURCES Stare weIl No <br /> Wt-",Other Well No. <br /> (1) OWNER. (1 <br /> _ 1) WELL LOG: <br /> Name ,er._`?�, T'T ' 1' Total dept, <br /> Address -T` - 0 ft Depth of completed.ell ft <br /> Formstrant Describe by color cbereeier ,fu of rrsaterial,esd sirtteture <br /> v r F ft to ft <br /> (2) LOCATION OF WELL: <br /> County^ TT n TT\T owner s number If Guy 0 <br /> 4 <br /> Towusbtp Rant and S.,,. m*^� r j ;-1 ,7 � q <br /> Distance from etues road, ratltosda eat -, 1 T19 Pi 277� ; 6 Cjpjr a Shal <br /> y c^ i-Tr <br /> (3) TYPE OF WORK (check); <br /> 5T 68 1 ;;v <br /> New Well gJ Dip"" g ❑ Reco>sdlt,ontug ❑ Destroying ❑ 68 —4 qnrdq fine <br /> It destruction,desmbe material grid Procedure m Item 11 T 7LL r7 <br /> (4) PROPOSED USE (check). (5) EQUIPMENT: <br /> Domesuc ® Industrial ❑ Municipal ❑ Rotary 0 83 2o SA-d, <br /> Irrigation ❑ Test Well ❑ Other ❑ (Cable ❑ a <br /> Ocher ❑ <br /> (6) CASING INSTALLED: <br /> 6TCEL OTHER If gravel packed <br /> DINGLE DOUDLE <br /> Gage Diameter <br /> From To or of From To <br /> ft it Dmm Wall Bore & ft <br /> Cr i on F 76 <br /> Sue of shoe or well nag Size of ravel p <br /> Describe otnt Water Code Sec, 13752 <br /> (7) PERFORATIONS OR SCREER - <br /> Type of perforation or name of,creep <br /> Perf Rom <br /> From To pv per Size <br /> ft ft row ft. in X112 <br /> It <br /> (8) CONSTRUCTION: <br /> Was a surface nntnr7 sell pro+tded? Yes CK Na ❑ To-hat depth 0 ft <br /> Were any strata allied agatnsr pollution? Yes❑ No❑ Ii yes note depth of strata <br /> From ft to it <br /> From ft to ft Werk started 19 Completed <br /> Method of sesha C+Lt V WELL DRILLERS STATEMENT <br /> (9) WATER LEVELS: Thu well was drdlyd ander my lrar,sdactson and thu report is true to ter best <br /> Dapth at which rate nay knowledge and belief <br /> r wu Sint found tf know. {t of <br /> Semdrag Ind be(orc perforatta it known ft NAME IENNINGS BROS. <br /> Stand— level after rf,"Imit and de+elopm it (Person firm or corporation) (Tyyed or printed) <br /> (10) WELL TESTS Addressi m. 2 00 Gil e RLr�, I,; RD <br /> Pamir,test mads? Yes ❑ No C) If ya b7-ho.? MODES G CA F. <br /> rd Rd/min with ft drawdown after hr, [SIGNED] IV- <br /> emPerature of eater Was a chemical analysts made? Yap ❑ No ❑ I(Irrit DrWer) <br /> Was electric log made of well? Yes ❑ Ho �] If yea atnch copy - 6�2 i_ tuJ l ti s <br /> License No_ � Dated I <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR t88 (REV Gall 54291-050 10-45 Dom 7Rtpcar <br />