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STATE OF CALIFORNIA -' Do Not Fill Yx
<br /> bUPIlCA71i THE RESOURCES AGENCY
<br /> Retain this copy DEPARTMENT OF WATER RESOURCES 1\��
<br /> Q 116738
<br /> WATER WELL DRILLERS REPORT state well No
<br /> Other Well N*. r))- 70% 17.
<br /> (I) OWName ,�ER:: F
<br /> WELL LOG:
<br /> Ntdress 1+IC^ rrrh r: nrrl of mtd dt 122ft.
<br /> nuf1" en: Drvrilr 6r rota•.rN.arrer,,lar of,•rmirf,raJ urur..r F
<br /> ft.
<br /> (2) LOCATION OF WELL:
<br /> c.a.,. S s n jonnuiJ3awn mhr.,if.n
<br /> Log
<br /> Ta�nahiP•R.n t and knion t,
<br /> Di.nnee from eitin,rn.J.,nilrotJ..eu., m1bill1'
<br /> u It1] & V 1 +, T;
<br /> (J) TYPE OF WORK (chech): —92
<br /> r,
<br /> New well 1X Deepening Q Reconditioning Q Dcttroying [�
<br /> If dnlrurPon,drscribe malerial and praredu:a in Urn,11. -
<br /> 4 (4) PROPOSED USE (check): (S) EQUIPMENT Pead & arPFIB3
<br /> Domestic LV Industrial ❑ Municipal ❑ Rotary ® r
<br /> r Irrigation ❑ Test Well ❑ Other ❑ Cable j
<br /> Other ❑ �O ��„ ^
<br /> (6) CASING INSTALLED: —�'�a
<br /> STEEL:X OT."'. If gravel Pa cd - —
<br /> SINGLE® DOUBLE
<br /> Gage Diamrtcr
<br /> Fran '1'u or of From To
<br /> ft. it. Diam. Vi'all Bare ft. Ft.
<br /> O
<br /> _ E
<br /> Sm.of,hw 11.inr� Sir of er.rd: i'
<br /> Uerribe i+.n, � I
<br /> (7) PERFORATIONS OR SCREEN:
<br /> jyP,.f wrfur.riun ur nrme of......
<br /> Perf. ROW, _
<br /> 14am To per per Size
<br /> ft, ft. row f, in.x in.
<br /> n �
<br /> — i
<br /> (8) CONSTRUCTION:
<br /> w......rr.rr,.niu,r,r.l arav,dr.il Y„F \„.` T.wh.r d,r'h fr.
<br /> tad LLt> Y„C N,.C ff,rYnV,r Jrr,f.of,.r.,.
<br /> trwn 1•.:c !., _ 4'orl,u_n•J`m -1 is r7i, .CamPle_rd 11
<br /> f1.rlu,J of...r,nr t G:R iii .. WELL DRILLER'C STATEMENT: ..
<br /> (9) WATER LEVELS: rhio uyll u at drilled ender any jurirdirlion and lhi, rrpnrf i. !rile in Ar bet
<br /> rr(my knowfrdge and belief.
<br /> urore.+ -hill. ..err ..fine rnand,it knnw„ f..
<br /> I
<br /> '.,.nJine level wrarr arrfon.nt. .f len. fe. NAAiF d
<br /> r• T% n
<br /> Sandier Ir,rl able lar.e�nr and J-.•I n '1'rerun,firm.nr roe ar.,icn '!—
<br /> tar �ninr I:. a 11 i or-)nnlr
<br /> (I0) WELL TESTS: Add-.+ 2 500
<br /> w„prmp ir..mads• YM ^ Nn x if re,,hr whno?
<br /> Yi,IJ. ..l.1m r..h 1t.dr.•dn .f„r _hr•- iSIGN Edi
<br /> T.man.ru...f.• orae.rl,rm::.t.n.6,n,..rile.+ 1':, ,-'j �N.,.r""]_
<br /> w�. rlrc t,ir I..e Mair of Yr. r'I Nu I.ice•ir No....29lb4- ••1 _
<br /> J2-} . 191�4,
<br /> i
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR ISIS -REV s.ne.
<br /> onaaw era tar rwr.(]y era
<br />
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