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zs S vi4-e— <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 252878 <br /> ice of Intent No. State Well No. <br /> Local Permit No. or Date. 87—3 188 Other Well No. 0-- (E fAA <br /> (1) OWNER: Name (12) WELL LOG: Total depth 18 5 _ ft. Completed depth 185 ft. <br /> Address 4491 I from ft to ft. Formation(Describe by color, character,size or material) <br /> City_ Trary , CA zip — 7 Top Sni 1 <br /> (2) LOCATION OF WELL (See instructions): 7 — 14 Sand <br /> County Owners Well Number <br /> Well address if differ nt from above 47 - 55 Sand <br /> Township 0.3 Range Section <br /> Distance from cities, roads, railroads, Fences. etc. 154 - 156 <br /> of Durham Ferry & Bird Rd . 156 - 168 Clay . ` n <br /> 1 - 185 Gr a v elk <br /> (3) TYPE OF WORK: — V <br /> New Well T Deepening El — <br /> Reconstruction ❑ \\ <br /> Reconditioning ❑ ^ <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe ` — - <br /> destruction materials and pro- \ Z-, ^� <br /> cedures in Item 12) \\�� <br /> (4) PROPOSED LS <br /> Domestic <br /> Irrigation r <br /> Industrial \` ❑ <br /> Test Well ; ❑OAer <br /> —r`. -X <br /> WELL LOCATION SKETCH <br /> 1 (5) EQUIPMENT: GRAVEL PACK: <br /> Rotary X] Reverse ❑ [a,AJ Nod <br /> Cable <br /> ❑ Air ❑ \ efenof bore / <br /> Other �, . — <br /> ❑ Buck av rom <br /> (7) CASING INSTALLED <br /> Steel ❑ Plutic n Ty oftion ovr siu o Q _ <br /> I From T Gage orr� t <br /> I ft. f ii Wall \ v t. size _ <br /> 0 18- 16o 16 s \ rrrppn <br /> — <br /> s — <br /> (9) WELL SEAL: — <br /> Was surface sanitary seal provided? Yes R] No ❑ If ves to depth og ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. <br /> F <br /> Method o[scalingH-E Work started r' 16 19—&2 Completed 19� <br /> (10) WATER LEVELS: WELL DRILLERS STATEIMENT: <br /> Depth of first water•if known ft. <br /> iThis well was drilled under my juasdiction and this report is True to the <br /> Standing level after well completion 20 ft. hest of mf knowle ge and belief. <br /> (11) WELL TESTS: Signed _d��i ``-,�� <br /> Was well test made? Yes ElNo a If yes,by whom? b (well Driller) <br /># eeoflest Pump Railer ❑ Airlift ❑ NAME- HENNINGS RRQS_ DRTI.1_ TNr, ('n _ , INC <br /> Ith to water at start of test ft. At end of test ft {Person,firm,or rn ration](Typed—printed) <br /> Discharge gal/min after honors Water temperature Address_ 3525 P E L A N D A L�,.A.1!_F- <br /> Chemical analysis made? Yes ❑ No EX if ves,by whom? City M n rl E S T n , CA ZIP �— <br /> Was electric loK made Yes ❑ No Q If ym attach copy-to this report License No. 2 4 4131 2 Date of this report 2R 9t <br /> DWR ISO IRLV• i2-eei IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM K 96355 <br /> 1 <br />