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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCE, <br /> WATER WELL DRILLERS REPORT N0. 252922 <br /> lee of Intent No. Stale Well No. <br /> Icul PormR Nn. or Dale AA RRQ Other Well No, <br /> ( 1 ) OWNER: Name (12) WELL, LOC: Total depth 170 ft. Completed depth125 ft <br /> Address from EL to (b Formation ( Describe by color, character, .size or material) <br /> caly -- l at hro R , r a r,e�'2iP <br /> (2) LOCATION OF WELL (See instructions): 3 — 5 Hard Pan <br /> County . San ,1 n A n I I i n Owners Wt ll Number 19 rjA %j <br /> — <br /> Well address if different from above <br /> Township /� Ran <br /> Range r <br /> ' <br /> ..— Section <br /> Distance from cities, roads, railroads, fences, tole. 6001 Nn nf 40 _ <br /> east side inf <br /> X <br /> (B) TYPE OF WORK: — <br /> New Well EX Deepening ❑ — <br /> Reconstruction ❑ — \ <br /> Reconditioning ❑ v <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> �. — .• Cry `,y/ <br /> destruction materials and pro- 1 <br /> cedures in Item 12) - \ <br /> (4) PROPOSED US� _ <br /> Domestic <br /> Irrigation _ <br /> Industrial <br /> 'rest Well l`•, \ \� ❑ <br /> Municip/al `,, y� ❑ _ <br /> Other ❑ . . _ — <br /> WELL LOCATION SKETCH "(Deuribe) <br /> 1 (5) EQUIPMENT: 148). GRAVEL PACK: - Sand ..1, _ <br /> Rotary Q( Reverse ❑ Yes (X No EJ Size dravel <br /> Cable ❑ Air ❑ s., O\•eterof bore fl <br /> Other ❑ Bucket_. ❑ Pakedfrom _Zn to 195 —e — <br /> (7) CASING INSTALLED: r ` 1 (8) PERFORATIONS: <br /> Steel El Plastic a 6rretE .❑ Type. <br /> ofperfontionorsize nEsereen - <br /> From To (--`."Diu. I Gage or .krom To -�$ of — <br /> ft. ft < iii, Wall ` Et:'- ' •Et'�` e'size <br /> 0 125 160 105 C ,Acreer <br /> \ Y — <br /> (9) WELL SEAL: <br /> Was surface sanitary met provided? Yea Q No ❑ if yex to depth 70 ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft, <br /> Method of sealing Work started F o h�GG 15.__$8 Completed 19— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known R. This well was drilled under ml. Jurisdiction and this report is true to the <br /> Standing level after well completion 9 S ft. best of mp knowled a an` bellej. ( <br /> ( 11 ) WELL TESTS: C' j� p It, n a <br /> Signed <br /> Was well test made? Yes No Qd if yex by whom? (Well D iller�—�-- <br /> eoffret Pump El Bailer C1 Airlift El NAME HENNIN6S Runs . nRnIItJG r0 , -i-N.G <br /> h to water at start of test _ ft& At end often ft' 3525 (Person. <br /> FI n.fiirm, orDA , F om )F y ar prime3S <br /> Discharge �_ gal/min after �._ hours Water temperature, Address <br /> Chemical analysis made? Yee [] Novo Ify(nb,• whnm? Cur MOUESTO CA- ZIP <br /> Was electric Ing made Yn ❑ Nn �] If ax attach wpy m this report License No. Date of this report 8 5 <br /> DWR tea IREV. I2-80l IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 06 16355 <br />