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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> Pile with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 2 8 9 0 0 E <br /> ce of Intent No. �" State Well No_ <br /> Uveal Permit No. or Date R A— F+n Other Will Nn.03SOS ?.moi? <br /> (1) OWNER: Name I12) WELL LOG: Total depth 11 Fid ft. Com pleteddepth 1 F�,n ft. <br /> Address from ft. to ft. Formation(Describe b} color. character, size or material) <br />"'. city_ T-rr—C zip 0 - 6 To Soil <br /> (3) LOCATION OF WELL (See instructions): 6 — 14 C I a <br />` County ':i A n .1 n a O I1 1-n Owner's Well dumber 4 — <br /> 25 Sand & Gravel <br /> Well address if different from above 4876 <br /> _ <br /> Township `O 3 s Range 0 5 E Secti <br /> Distance from cities, roads, railroads, fences, etc. t <br /> 0 - 8 <br /> 86 - 91 <br /> (3) TYPE OF WORK: 91 — 1 0 7 C I d <br /> j New Wet]XX Deepening ❑ 107- 108 )-�,\v P V <br /> Reconstruction ❑ 108- X48 <br /> Reconditioning ❑ <br /> 148--:',1'56 Grave 1/. <br /> . i <br /> Horizontal Well Cl1 56- 16 C 1 a N <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in [tem 12) J / •,� <br /> 7 <br />. (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial ❑ <br /> Test Well \� °i ❑ <br /> MunicivaN C] <br /> er <br /> WELL LOCATION SKETCH ibe) <br /> \\. i <br /> (5) EQUIPMENT: CRAY' i, CK: &-d n cr &, <br /> Rotary)U Reverse [] Y�c l5pl No'� 'Si <br /> Cable �� u <br /> ' ❑ Air © etelwf bore <br /> Other ❑ Buck e om <br /> (7) CASING INSTALLED. (8) PER Od�S: — <br /> Steel ❑ Plastic E n Ty ofP74on oVr size of Q — <br /> From T i Cage or T t <br /> ft. ft. i Wall I. <br /> size — <br /> (9) WELL SEAL. — <br /> a Was surface sanitary seal provided? Yes EX No ❑ If yrs,todepth 1 Q o ft. — <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealing BENTONITE Work started 19$ai Completed 19--— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water.if known ft <br /> � <br /> This well was drilled under rny juriwlicrinn and this report is true to the <br /> n <br /> Standing level after wrll empletion 22 ft. lies:of my krlutcled a ane!belief. <br /> (11) WELL TESTS: Signed ?-.c,— <br /> �y. <br /> Was well lest made? Yes Cl No (M If yes,by whom? (Well Driller) <br /> N,of test Pump ❑ Railer ❑ Air lift ❑ 1t jylE H E N U N G S BROS . D R T T N , r 0_ t I N C <br /> .epth to water at start of test fl. At e•nd of test it, 1 Perlia(,firm,•r rvirpuration)(Typed or printed) <br /> Discharge gal/ruin after hours Water lernperature.. Address 352-5 P E L A N"'IAT'l F A`(F <br /> Chemicelanalysis made? Yes ❑ No M If yes,by whom? City M O D C S TO . CA LIP Cl 5 15 1; <br /> Was rlertric hrg nude Yrs ❑ No M if ves,attach copv to this report f.icorue Nu. 290813 Uatr of this report <br /> OVrR IBa (REV. 12-Be) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br />