Laserfiche WebLink
THE RESOURCES AGENCY <br /> ORIGINAL - cPARTMENT OF WATER RESOUF IS 1 �� T <br /> O 98907 <br /> Pilo with owl, WATER WELL DRILLERS REPORT Stare Well No. _ <br /> Other Well No. 74ams221 W <br /> ( t ) OWNER : ( t1 ) WELL LOG : <br /> Name Totil depth 1 15 ft. Depth of Completed well ft. <br /> Address rarm,non: Deseribe by voloa eb3rar:er, size a/ Inaledal, and elr.rrnre <br /> h. ft. <br /> ( 2 ) LOCATION OF WELL : Ton qn -11 <br /> Uwner'r number. if anv <br /> rownship. K;tnge. and sea <br /> 8 . pn clay <br /> D,�ane L„ ands,niuoads. rte( a <br /> a s [ n o <br /> ( 3 ) TYPE OF WORK (check) : Of Roth Rd . Shrill; SizInd <br /> New Well fa Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If dwtnalion, Aereribe rnulerial acrd procedure iu [lent It , <br /> (4 ) PROPOSED USE (check) : ( f ) EQUIPMENT : C <br /> Domestic "W Industrial ❑ Municipal ❑ Rotary 0 Clay <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ _ nMay <br /> ( 6 ) CASING INSTALLED : _ K _ 'q hit? I e <br /> STEEL : ][ OTHER : If gravel packed op 11 rl <br /> _ po • <br /> SINGLE M DOABLE l� 12 aiT <br /> Gage Diameter <br /> Front '1'n or of From To <br /> [r. Po. Diam. Wall Bore ft. ft. <br /> 1 . 61 ozzi 07 Send Ar Sb@ In1 <br /> Sita of lnue ur well ring! size of state: pen <br /> utt rine joint <br /> ( 7) PERFORATIONS OR SCREEN : <br /> Type of rwirforidon or Piano of strien q1 n r. <br /> Perf. Rows <br /> Fru112 To per per Size <br /> irfr4 row ft. <br /> k II <br /> ( R ) CONSTRUCTION : <br /> Wastnitary soil provided ? Yes No ❑ To what depth ft. <br /> Werelily .tt,ta .ealed airliner pollution ? Yes ❑ No ❑ If yet, nate depth of tilde, <br /> Emm is, to it. G <br /> Fm n, (s, m It. Work warted �6 19 1+, Completed 19 <br /> Hrthod or telling Bentonite WELL DRILLER'S STATEMENT: <br /> ( 9 ) WATER LEVELS ; This well was drilled tinder soy palydfnliou and this report it true to the best <br /> of my knowledge and belief. <br /> Depth s which wutt wis fine found, if known ft. <br /> ,ndin.e level lainre perforating, if known ft. NAN114: Flenning.9Bros . Dxilliri or Co . Inc <br /> undin level after perforatln and developing fr. 11'ertnn, firm, or corporation) (TYPed Prinlyd) <br /> ( to ) WELL TESTS: Address Wit RumbleRdds <br /> Cs pomp ,err node? Ya a No M it Yes, by whom? f <br /> IJ: a,l./mi wish fv'Jrawdown titer hit. [SIGNED] <br /> W19�il 11 <br /> eof avatar Was a chemical analysis made? Yes n Na ( Well Driffer <br /> Wit log nadeof well ? yes No 31 If Yesattack copy License No. f1R17Z Dated (• — F — 19-74 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> OWR 1881Rev. 9,00P 23179.950 1,48 eon TRIP AD OSP <br />