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U VAUN V YLILA I L <br /> 'Ise to comply with STATE OF CALIFORNIA DO not rill to <br /> ocal requirements THE RESOURCES AGENCY <br /> �eJ <br /> PARTMENT OF WATER RESOURCES NO. 21480t <br /> na of Intent No. L WATER WELL DRILLERS REPORT State Well No. <br /> ,mal Permit No. or Date 76-557 W Other Well No. <br /> (1) OWNERRRL:+��N.yya�nne pJO@ eIQSE (12) WELL LOG: Total depth�f. Depth of completed W�,ft. <br /> ddress 4GJL4L. Ys I�Uh c • from ft.r� to ft. Forroatiogns(Describe by color, character, size o material) <br /> � OSP lii• 7iP V- 7 TOR 8011 <br /> 2) LOCATION OF WELL (See instructions): -10 Clay <br /> •.n,nty San .Ipg.aui-n owners Well Number 10-15 Sand_ <br /> i�ell address if different from above 15-55 Clay" <br /> 14)wnshiPSRange . SecHo SAnd <br /> )istance frnm cities, roads, railroads,fences,etc <br /> ilmi Fast of Fs <br /> South side <br /> (3) TYPE OF WORK: <br /> New Well �X Deepening ❑ <br /> Reconstruction ❑ _ C1 11 <br /> Reconditioning ❑ y„ <br /> Horizontal Well ❑ 7195 <br /> Destruction C] (Describe y — <br /> destrvction materials a@d <br /> Procedures in It.. - <br /> (4) PROPOSEW v4S <br /> Domestic <br /> Inigatior✓4"-;�t <br /> Industrial _`q ') ❑ { <br /> j <br /> cFt well `.'�! ❑ •vv1 — <br /> St <br /> Mount a., <br /> i <br /> Issas WELL LOCATION SKETCH - Other .; ` ❑ <br /> (5) EQUIPMENT: (H) GRA L PACK: <br /> Aotary Reverse ❑ No S <br /> :able ❑ Air ❑rte ter of bore <br /> 17) CASING INSTALLED p`::, IS PERFOR 31 S• $l , <br /> heel m Plastic ❑ d Type of Pe' 'on oize of screeP""_ \' — <br /> Froin T Dia. "fir F 1 To il <br /> ft. in. Wall t =,A. ft. Sl'3ce�" — <br /> 12 R I — <br /> r <br /> (9) WELL SEAL: <br /> `Was surface sanitary seal provided? Y,3V No ❑ If yes, to depth 5_ft. <br /> Were strata sealed against nollutinn? Yes ❑ No ❑ Interval h, — <br /> Method of sealin= Work starte 19 ComPlet i 19_ <br /> (10) WATER LEVELS: WELL DRILL R'S STATE ENT: <br /> rDepth of tint water, it knoaa` 1. This uell wax drilled under our iur(sd(es( tole eat omo <br /> on nod IN., renorf (x ee to the heat <br /> Standing level after .yell camnletin H, knornledge nor! helial. <br /> 111) WELL TESTS: SIGNED <br /> Was well teat mode' les lI No C1 If 'es, 1, wh... ? ,\Vrlh'✓ :Ilrr) <br /> `Type of trot P nn L' i 8a-10- G Air eft ❑ 1 _NAVE_ kr <br /> Deptb to .eater at .t n f test ft. At end of test ft I n M,$,)nfQr1 ' Pam* Inc., <br /> Discharge v I ,au' hoop Water temPeranna. Addm. 2500 W -h Rd� ------ <br /> Chemicel al , made +,, is Nn if by whnmt <br /> �W el.tri'. l g d [j C t ff ftach P to thi., P rt I L' — t th a refant� <br /> owe 168 acv. I.rs, IF ADDIT1 NAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM .,l,a-ssc,.>c sov au.o1c,a_v <br /> Issas <br /> L <br />