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Jt I Z. <br /> ORIGINAL— _ -- - -=WATER -WELL- DRILLERS -REPORT----- — Do Not Fi11In r- _ <br /> File with DWR (Sectwnm 7079,7060,7081,7082,Water code) NO <br /> • 21641 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> DEPARTMENT OF WATER RESOURCES State Wal No <br /> Other Well No� <br />' (1) OWNER- (11) WELL LOG: <br /> Name Orvel Bird Total depth it Depth of completed well 81ft <br /> Address Rt, 2. Box 3L Formsuon DrttT.br by color,cberartrr,rise of Psrtrrsrl,rwJ slrsscla+r <br /> it to ft <br /> (2) LOCATION OF WELL- <br /> County Owner s number sf any <br /> Township Range and Scctson 123 ClAY <br /> — <br /> Uutance from eines roads ratlmads e <br /> F - <br /> (3) TYPE OF WORK (check) = 54 Sand k, Grayel <br /> New Well Deepening © Reconditioning ❑ Destroying <br /> If destruction,describe material and procedure to Item 11 <br /> (4) PROPOSED USE (check.)• (5) EQUIPMENT <br /> Domestic ® Industrial ❑ Mumclpal ❑ Rotary Ix <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL OTHER If gravel packed <br /> 81NGLEr DOUBLE ❑ <br /> ' Gage Diameter <br /> From To or of From To <br /> it it Dram Wall Bore it. it <br /> Q 5 E <br /> a, <br /> Size of shoe or well ring Size of Rnvel <br /> Deacnbe lomt <br /> (7) PERFORATIONS OR SCREEN <br /> Type of perforanon or name of screen <br /> Perf Rows <br /> From To per per Size <br /> it ft row it to x in <br /> 66 93 <br /> (8) CONSTRUCTION. _ "ter `-cc" <br /> Vas a surface aanusty teal provided? Yet 0 Na 3t To what depth it <br /> Were any strata sealed against pollution? Yes❑ No If yes note depth of amts <br /> 1 From it to It <br /> From ft to it Work started 913 2 ]9 completed -9,111, 1966 <br /> Method of sesha WELL DRILLS 'S STATEMENT <br /> ' (9) WATER LEVELS- Thu well was drilled under ray jurisdiction and thrs report is true to the best of my knowledge and belief <br /> Depth at witch water was first found if known ft �s <br /> Standing level before peefont.ng if known it DAME EQUIPMENT CO. INT.+. <br /> Stondink level after perforating and developing it (Person firm or corporstwn) (T'yped or printed) <br /> (1.o) WELL TESTS Address <br /> rep ust made? Yes §t No ❑ If yes by whom? a if 0 nia <br /> 09 <br /> Rol/men with it drawdown after his [$IGFreB] <br /> (Well Dn11rr} <br /> 10crupers'eure of water Was a chemical analysis made? Yes ❑ No <br /> Was else tric log made of well? Yes 0 No If yes attach copy License Na ated Ont nb Ar Z.?,_, 19-66 <br /> SKETCH LOCA'T'ION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV 9 65y <br /> 6679t-990 10 69 90M TRIP(D A 09P <br />