Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA Do not flU m <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 201402 <br /> I <br /> of Intent No � WATER WELL DRII,LERS REPORT State Well No. <br /> Primp NO or Date2T Tam �� � "L 0/ /Q �j 22 <br /> T Other Well No /y �L ACL5 <br /> I) OWNER 16C, (12) WELL LM Total dep Depth of completed well-t <br /> Address 7 from ft, to ft. Formation (Describe by color, character, sae or material) <br /> City lap - <br /> (Z) LOCATI SMI� ELL see instructions) <br /> Gauntv +y_ Owner's Well Number MW <br /> ji- <br /> r� <br /> Well address if different from above - tiN'+ <br /> Town.hip ge _(ja Seam - <br /> t \ <br /> Distance from cxh roads,rarlmads fences etcrc�lky <br /> (s) TYPE OF WORK. ` <br /> �,r. New Weng Deepening ❑ <br /> ReconstruMon ❑ <br /> Recoaditionurg ❑ <br /> horizontal Well ❑ - <br /> Destruction ` <br /> destruction materials and <br /> procedures to Item 12y - - <br /> ��� (4) PROPOSED USE. - f <br /> Domestic 0 - -- <br /> hil AIL .. <br /> ` _ — Irrigation 0 - - <br /> VY Industrial ❑ <br /> Test Well ❑ - <br /> Stock CY, - <br /> Municipal Q <br /> WELL LOCATION SKE'T'CH Other - � - <br /> (5) EQUIPMENT (6) GRAVEL PACK - <br /> Rotary ❑ Reverse ❑ Yes A No ❑ Size - <br /> Cable ❑�4 ❑ Ihamoter al bore - <br /> other W -r Bucket ❑ Packect to - <br /> i N CASIN I ALLED l (8) PERFORATIONS - <br /> Steel ❑ Plastic JT CongMte 0 'Type of perforaben or size of screen. -From To, , DI& Ga r F�*�~,,' .�' To <br /> ft ft ` -to Wall ft`Z. ft. <br /> 19) WELL SEAT. <br /> Was surface sanitary seal provided? Yes je No ❑ If yes, to d�Were strata sealed garast llution? Yesk? No ❑ Interya - <br /> Method of sea +�+ Work �13 Complrtrd 19 <br /> (10) WATER LEVELS ^ .� WELL DRILLER'S STATEMENT <br /> Depth of first water, If known L� + � t Thu well was drilled under my turfadktion and this report is true to the best of my <br /> Standing level after well completion h knowledge and behef <br /> (11) WELL TESTS Sic; <br /> Was well test madco Yes ❑ No of ver by whom) y _ J e (weOA rL C-P <br /> Type test Pump C2B Bailer ❑ Air lift❑ NAME p.\F��J � �]��-�* © <br /> to water at start of test tt At end of twt ft (Person, Prim. or corporabo (hyped ar prtnzed) <br /> arae 1/min after 1+nazrn Wmer tempera Addres <br /> • sI analysis made? Yes ❑ No ❑ If ycs, by whwn? <br /> `1G-w electric log made Yes ❑ No ❑ If yes attach copy to this report License No33 ate of this repo <br /> DWR 188 (rrev 7 7E) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />