|
• STATE OF CALIFORNIA Do Not Fill In
<br /> THE RESOURCES AGENCY r�
<br /> TRIPLICATE DEPARTMENT OF WATER RESOURCES N2 94589
<br /> Retain 4hiS copy WATER WELL DRILLERS REPORT sate well No.—,)1.--8 f
<br /> Other Well No—
<br /> (I) OWNER: (1 1) WELL LOG:
<br /> Name I _MM —�eyw� _ Tmd J,r,l, rt. Ihrth or eam0le,eJ.rn ft
<br /> Address 2MM + _ v rm,ao : n.,r.;: ti,.i..,rs...re.r,,i:,nl.rrr..fer,a.J u.......
<br /> (2) LOCATI OF WE L:
<br /> Co„n,. o.nrr•n�rnhe,.it,n - -
<br /> Ta.n•hir.R,nar.mJ Srcnon � '
<br /> Di......from cities,ro,J,.railroad•,rtc.� r+,� iy1►���yo-
<br /> (�) T O V7:3R (c « _ Kroll
<br /> New Well j f'eepening 0 Reconditioning ❑ Drc:roying ❑ 0
<br /> I/destruction,dejc,ibe material and procedure in llrm 11.
<br /> (4) PROPOSED USE (check.): (S) EQUIPMENT: iin
<br /> Domestic industrial ❑ Municipal ❑ Rotary ❑ g
<br /> Irrigation I Test Well ❑ Other ❑ Cable
<br /> Other ] t
<br /> (6) CASING INSTALLED:
<br /> If
<br /> STEEL: OTHER: ;f gravel packed +_•
<br /> SINGLE DOUBLE❑ ------�
<br /> Gape Diameter I rrr�'�����fftttt
<br /> From 'I'o ' or of Prnm I In *10rr
<br /> ft. ft. hiam. wall Ito,. fs. ft.
<br /> _� aisfY 409r .ii;-i�"sJOPlp—e
<br /> rr>•—• Mgwwa
<br /> w „1•hw.. +til r rbee Wft cifol,
<br /> tsr..ribr w + � '9r
<br /> (7) PERFORATIONS OR SCREEN:
<br /> este..r rrrior„i.n,,, „!• ,
<br /> _ rerf. Row's
<br /> - Prom-- -- To - -- per - per tii7c _
<br /> It. ft. row ft: in.:t in.
<br /> (s) CONSTRUCTION:
<br /> T.,.h,:Jrrd��� is
<br /> —"I A=_.—
<br /> \XTLL,DRILLER'S S7�\TGWNT:
<br /> Tbi, well uv, drilled rind., my iu,i,,Lttion and/hit r,p•,ri is 1•nr to thr be..
<br /> (9) WATER LEVELS: nJ my l'oI.lydg. nJ h,li,f.
<br /> Urrth at .h.,h . ..
<br /> —`--^-
<br /> ,a,”
<br /> (10)e WELL TESTS: AJdre., �1111"W ATG
<br /> ISn:Nlul -_
<br /> 4m rt., .:r _: ,�.:-. n—'I• .Jr ! Li:en,c \u.��.. _ _-_—._Dale _.__. !'/. __
<br /> SKETCH LOCATIDN OF WELL Or,. REVERSE SIDE
<br /> ..,.. ., a.,e..r..,•!,o nae
<br />
|