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1 Z. <br /> ORIGINAL WATER WELL DRMLERS REPORT Do Not NU In <br /> File with DWFt wa. /� <br /> fS«t7074,7080,7.091,7091,Wacar cad. fFel) N© `16`*1 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> DEPARTMENT OF WATER RESOURCES state Well No <br /> other weu N C) —7R <br /> (1) OWNER. (11) WELL LOG: <br /> Name Orvel Bird Total a o <br /> Address �^tft Depth or completed well ft <br /> Formanon Describe by color eharartrr,nu of%xateml,cad sduetorr <br /> it to 91 ft <br /> (2) LOCATION OE WELL: <br /> county Owners number t£arty <br /> Towasbsp Range and Section <br /> Distance from hues roads nd-.ds e <br /> F _ <br /> (3) TYPE OF WORK (check): <br /> New Well ][) Deepemiag 0 Recondtttonmg ❑ Destroy=s ❑ <br /> If destruction,describe material and procedure in Item I I <br /> (4) PROPOSED USE (check). (S) EQUIPMENT. 67 Grave <br /> Domestic ® Industnal ❑ Mumclpal ❑ Rotaty <br /> Irngation p Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL OTHER If gravel packed <br /> GtNGLEXJ DOUBLE ❑ <br /> Gage Diameter <br /> From To or of From To <br /> it it Dtam I Wal! Bore ft ft <br /> O 8 <br /> Sae of sloe or well Haft Site of i;nvel <br /> Duenbe peat <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of Perforation or name of screen <br /> Perf Rows <br /> From To per per S=e <br /> ft ft row it m s m <br /> 66 <br /> (8) CONSTRUCTION. +t,tf=r Cc a 2 je„ <br /> Was a surface.an-tary seal provided? Yet ❑ No To what depth ft <br /> Were any strata sealed agauut pollution? Yet ❑ No If yes note depth of strata <br /> From it to ft <br /> From it to ft Work started 9 ZI14 Completed 74 <br /> Method of sea[saK WELL DRILLS 'S STATEMENT <br /> (9) WATER LEVELS: This well was drilled under my furadtctron and ibis report is true to the best <br /> Depth at trbseh name was fine found if known ft of my knowledge and belief <br /> Standing level before perfarattag if known It NAME EQUIPMENT C 0 a INC. <br /> Standing level after rfontsn .rid devei to (Person Irm or corpor.uon <br /> g ft ) (Typed or priated) <br /> (10) WELL TESTS Address Box 2L,,8 <br /> -m int made? Yes No ❑ if yea by whom? California <br /> ;tat/min wsih ft dr.wdown after hrs [SIGNED1 <br /> T emperatan of water Was a chtmseil analyns made? Yes ED hIn (Well Drlllrr) .01 <br /> Was electric 106 made of well? Yes ❑ No if yes attach copy Lacense No 91-()5119 nate 19 e;() <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV 9 651 seaw iso 10 to bowl-rRl!0D one <br />