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w ff Ul� if <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES n 8 9 6 0 Z15 <br /> WATER WELL DRILLERS REPORT No. ! <br /> .dice of Intent No. State Well No, <br /> Local Permit No. or Date 88-2577 Other Well No,03S 40-ITE <br /> (1) OWNER: Name Ray Targowski Const—_ (12) WELL LOG: Total depth_2 78 Ft. Completed depth 14 8 ft. <br /> Address from ft. to Ft. Formation(Describe by color, character,size or material) <br /> Citv Triry , Car ZIP _ <br /> (2) LOCATION OF WELL (See instructions): 6 15 <br /> County _San- rl n A n l l i n Owner's Weil Number <br /> Wel!address if different from above 4820_ <br /> Township o 3 rJ Range _ O5 Section <br /> Distance from cities, roads, railroads, fences,etc. <br /> of Bird Rd . 65 - 67 Gravel <br /> 79 - 93 Grav <br /> (3) TYPE OF WORK: 93 — <br /> New Well U Deepening ❑ <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ �^ <br /> \ <br /> Destruction C3 (Describe - <br /> destruction materials and pro- <br /> cedures in Item 13) <br /> (4) PROPOSED US _ — •,--, % <br /> Domestic _ ! _ <br /> Irrigation <br /> Industrial \ \ \ ❑ /� _ �/l '� <br /> Test Well \ i ❑ _ <br /> Munici¢tt�� ❑ <br /> O er \> � � r <br /> WELL LOCATION SKETCH ��) /�• v �` `�/�. <br /> (5) EQUIPMENT: GRAV-@L CK: ,�arrdr' <br /> Rotary�( Reverse ❑ %)a No`-ElSize { <br /> Cable El Air Elete of bore <br /> u^ 7 -� \' \L <br /> Other ❑ Bucke ed Eram -,J�o 0 to. 'I a R \J <br /> (7) CASING INSTALLED. (8) PER Tlt�}YS: — <br /> Steel C3Plastic n e Ty of fo 'on or size of r Q From D, Gage or t <br /> Et. f Wall t. size — <br /> r <br /> ,, - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes}: No ❑ If yes,to depth 1 n n ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealing 8 E N T 0 l`!I T E Work started IS-&& Completed l9__ <br /> (LQ) WATER LEVELS: WELL DRILLER'S STATE'(ENT: <br /> Depth of first water,if known ft. <br /> This ter!l was drilled under my jurisdiction and this report is arae to the <br /> Standing level after well completion 21 ft. hest of my knowledge and 1whej. <br /> (11 WELL TESTS: r <br /> ) Signed �.Gi�_CLLIi ,-k \_c-SL-`r-`el_L� _ <br /> Vas well fist made? Yes ❑ No CM II yes,by whom'? (well Driller) % <br /> `of test Pump ❑ nailer ❑ Air lift ❑ NANIF H E N N T N G S R R n S _ D R T I I T N . r n _ , T N C_ _ <br /> epth to waler at start of test ft. At end of test ft. (Persovo,firm,nr atrpomtion)(Typed or printed) <br /> Discharge gal/min after hours Water temperature Address 3 5 2 5 P E L A N D ALE A V F _ <br /> Chemical analysis made? Yes ❑ No IN If yrs by wham? City n D F STOy CA ZIP o95 3 5 fi <br /> f Was electric log made Yes ❑ No Q0 If yes,attach copy to this report License No. 2 Q n$I Date of this report 9 <br />� owR 188(Rev. 12-e6) <br /> IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM e6 96355 <br />