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ORIGINAL WATER WELL DRILLERS REPORT" Do Not Fill In
<br /> File with DWR (Sections 7079,7090,7021,7092,Water Cod.) N° - 43054
<br /> d�F�pEIAL 1-",�5� THE RESOURCES AGENCY OF CALIFORNIA ustr Cwel1 Na �`"
<br /> DEPARTMENT OF WATER RESOURCES
<br /> ft teT
<br /> C06e Other Well No -
<br /> (1) OWNER- (1 i) WELL LOG.
<br /> Name1 li t.--F Total depth 2A0 ft Depth of completed well ' ft
<br /> Address 3 a.�� sC+.-.--�,-r,c 3 r't Drs� ='e
<br /> 3 Formation Drscrsbe by Coro�. ch^arrt
<br /> cter sn stract.re
<br /> Iu 1Ve- Z -- ---' 2, . f,ae i
<br /> 1 ' -- �"r� ^
<br /> (2) LOCATION OF WELL:
<br /> ft
<br /> ^ _Tr
<br /> County s�..,�" T".�-„ �' '_^_ Own"a cumber if any � -- - r r T^-
<br /> 1 r{f Y "IS
<br /> ------;,A ,; r -r—
<br /> Township Range and Section i�,� q��,?� �'.�, � "r
<br /> Distance from cities roads railroads etc A , -�r 7- '�� .7^ "1 "` R Z-__----- i lD �� a - � ^r' �4
<br /> + rat ,- r'1� f,-r ., A-11'— - -- d di 19 'n,+�- 7
<br /> (3) TYPE OF WORK (check)• f'e e f' -3 t i \0 "^'-S ^r r4 r
<br /> l�V J V .JCY J J •.7—,
<br /> New Well [3 Deepening ❑ Reconditioning ❑ Destroying © � ' � ,r1 r,-7i. -
<br /> If
<br /> ^''"'i I f destruction,describe material and procedure in Item 1I ----- - r, h - " IT ^7n- -
<br /> (4) PROPOSED USE (check). (S) EQUIPMENT 29----1 2E\0 A� A' "^^ +'q
<br />' Domestic Q Industrial ❑ Murueipal ❑ Rotay ❑ --17,--0,7 ,-�r, h "a^` , - 'r
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ] ____1 tiJ 3 t o -- --f' ' r�
<br /> Other ❑ w,^ :- ter;t t hr , r ,-
<br />' (6) CASING INSTALLED. z = ^--- r7 7 3' '° '� V
<br /> STEEL OTHER If gravel packed ZZ
<br /> 77 3
<br /> SINGLE DOUBLE ❑ 1..,
<br /> Gage Diameter -- O2- a r: ` --, r t,'7 -'
<br /> From To or of From To -
<br /> it it Diarn Wall Bore ft it I Q -_ _ r d' "rs 1 0 1,n n •r
<br /> n^., r-C
<br /> Size of shoe or well ring �+ll-�^ Q,rc^ , Stze of gravel
<br /> Describ .+-
<br /> e sotnt ft !"s�-?•, a' r1 e7 r - n' - rr i
<br />' (7) PERFORATIONS OR SCREEN. ^ - y -
<br /> Type of perforation or name of screen -y 2
<br />' Perf Rows
<br /> From To per per Size
<br /> fr ft row ft in x in
<br /> 1 �
<br />' (s) CONS'T'RUCTION _ r NT4A
<br /> Was a surface sansrary seal provided? Yes".0 No ❑ To what depth F ft
<br /> L d� pec. _cE�w
<br />' Were any strata sealed against pollution? Yes❑ No❑ If yrs note depth of strap '
<br /> From it to It
<br /> From it to it Work stare �,--^ ^., E9 .7 ,comple
<br /> Method of sealing ^ o , - r +•^' - i' r� 3 -k +^�� WELL DRILLER S STATEMENT
<br /> 3 WATER LEVELS. This well was drilled under my )urrsdicirois and thss report is true to.4e(fest
<br />' ( ) V of my knowledge and belief J t'r
<br /> Depth at which water was first found if known ,r 1.24t
<br /> (� t
<br /> - ire .-��
<br /> Standing level before perforating if known - o^� - ^ 'fir - ' NAME-
<br /> (Person firm or corporation) (Typed or printed)
<br />'
<br /> standing level after perforating and developing it
<br /> l o) WELL TESTS. Address
<br /> Agump test made? Yes C] No If yes by whom? rt .! ,-
<br /> gal/min with it drawdown after hrs [SIGNED `
<br /> ( Drr!!rr)
<br /> Temperature of water Was a chemical analysis made) Yes ❑ No
<br /> was eleetrac lag made of well? Yes ❑ No If yet attach copy License No.,,,,� '�Q r'- --Dated a;�' -, 19 n.
<br />' SKETCH LOCATION OF WELL ON REVERSE SI[7E
<br /> DNR 1�8 i REV 0 R�1 06397 950 10 93 5074 TRIP(D A 08P
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