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-7 z"_ y 7 2(11F <br /> STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY ^ ^ <br /> TRIPLICATE DEPARTMENT OF WATER RESOURCES a i - `� <br /> -74 <br /> Retain this copy �. Smte'Cell No.. <br /> WATER "'WELL DRILLERS REPORT <br /> Other Well No-- <br /> (1) <br /> o -(1) OWNER: (1.) WELL LOG: <br /> Name f(ts il 1'ot,l J.rth r,. Drr+h nr romplrsed.ell h_ <br /> Addressi- n' T_-i Fm on: Unn;Lr F7 rnlor rbmrrrr,d:r eJ w rnL1,en/rtnrrerr <br /> ay �� - -- <br /> (2). LOCATION OF WELL: ' brmn* <br /> T­­h'n R nR +-d Src n30265, Ems, @.__ <br /> Distance from tide. road+.,.iIr d+.rtc.Aar" 'E u <br /> (3) TYPE OF WORK (check): <br /> New Well Deepening ❑ Reconditioning ❑ Uantroying ❑ ' — <br /> I/deslrrcliox,describe maim%al and Poredxrr in Ilrm 11. v <br /> (q) PROPOSED USE (check): (I) EQUIPMENT: ��� -�,"s — � <br /> Domestic n Industrial ❑ Municipal [I Rotary ❑ t - ,; - <br /> Irrigation ❑ Test Well ❑ O:hcr C] Cable a — <br /> Other <br /> (S) CASING INSTALLED: ���`� ,,��,ay—� <br /> STEEL: <br /> OTHER: <br /> If gravel packed7Vb.� — <br /> SING DOUBLE❑ — <br /> Gage Diameter <br /> From 'I'u or of From I To --- <br /> ft. It. Dim. 'fall Dore ft. ft. <br /> _A <br /> Ih -M '!`•tA�t< 7'x41• ��4R'14 " <br /> (7) PERFORATIONS OR SCREEN: <br /> erre ur perL.r al,cr«n — I — — <br /> Perf. Rows <br /> I;rom To per per Sire -- <br /> ft. ft, row ft. ire.x in. <br /> t <br /> fK) CONSTRUCTION: <br /> Yr._ \ `� Tn.h,rarrth ' --- <br /> u'+.+.urf+u..more wl prordrJ? <br /> f r. <br /> X1'0.n,• <br /> nLJ+ s rv!!us Yr,7. No If v Jrpsh„f.vv, <br /> ft. Cl <br /> �N . .�mrlrrr. If <br /> I ram f+.t„ It. <br /> Wf1.l.+URI(.I-I:R", STATEMENT: <br /> �trshaJ .r wdr Thi• ft(.11 xae .,rille.1 ander ,,.I lurisdi:lion a"ll lh' "Porf it lrxr fn!bt beet <br /> (9) WATER LEVELS: . ,xyt.,,,,1 1y, Ibelirl. <br /> NAME la Von raLluliot <br /> �undm< k,• � ir.r.. ,Lem.nr.span.,n) 1T7 fr/nr pvgrJ) <br /> wndm. tn.l,ir.r err f.nr`.< ,aJ Jr.rh.nn r` yi�. 1 611 — <br /> Addre,s Jr <br /> (10) WELL TESTS: <br /> V+,Fume tr -• � ' ,- --"�•.I <br /> 120 fft <br /> hr. lStcNtul — -- <br /> rrmrrr.t rr,.i.,err 1 <br /> it.r.,n.,.h r.•r. Lii cn,r Xo.________ __.._-___ _UJtrd--__— <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> T.I.Go o+• <br /> I <br />