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DEPARTMENT OF WATER RESOURCES I40v J b i ` 14 <br /> N'Jiee mf Intent No. ATER WELL DRILLERS REPO <br /> Ly unit No. or Date - - titrate Well No, <br /> hr: Other well Nil <br /> ( � JWNEII : ne_$g ( 12 ) WELL LOG ; Toad dadh 16p --- l G�• rar� <br /> I L Depth of campleteJ well�Y,yy/,ft. <br /> IJdresa_ s.L�lI3],-LC�s-_ R(f __ from ft. to ft, rnnnnuon IDe,_cribe by colon character,_ .rre or unterinO <br /> tune Rr nab Campo Cal yforni a ZiP - sand k nl ay brown <br /> ( 3 ) LOCATION OF WELL ( fire tnatructions ) : - 33 0. 1 ay <br /> cm: ntr_ San Jna -iiia O,.mer•., weft vmhher _ 33 5Q �.claa with sand <br /> — <br /> 1t'oll addmss if difvrent fr,,:n abnvr .--- — 78 sand <br /> 78 98 sand &. clay <br /> Oistuurce in]"' cities, roads. railroads, fences, etc, — n4 sand <br /> -- 101 - 111 cla <br /> 111 - 116 sand <br /> 116 - 11sand clay <br /> ( 3 ) TYPE OF WORK; - 11 - 1 6 clay blue <br /> New Well 2 Deepening ❑ 1 6 - - 1 9 sand & clay layers <br /> neconstruahm ❑ 139 - 160 sand cm <br /> irsp <br /> Reconditioning p <br /> Horizontal Well - <br /> Destmetfnn ❑ (Describe — <br /> destruction materials and <br /> procedures In Item 12)•' — .. <br /> ( 4 ) PROPOSED USE; - - <br /> Domestic <br /> Irrigation ❑ _ . . <br /> Industrial p _ <br /> Teat Well ❑ <br /> Stock ❑ <br /> Municipal ❑ — <br /> WELL LOCATION SKETCH Other ❑ _ <br /> ( 5) EQUIPMENT: ( R ) GRAVEL PACK: <br /> Rotary xx Reverse Cl Yes K) No ❑ Size penCable Cl Air ❑ Diameter of bore _ <br /> Other ❑ Bucket ❑ Packed from 607 to--545--ff, — <br /> 17s CASING INSTALLED: ( 8 ) PERFORATIONS: — <br /> Sleel ❑ Plastic ❑ Concrete ❑ Type rut perforation or size of screen <br /> From To To Dia. ,;ft or From To Slot <br /> ft, ft in. Wall ft. ft. size _ <br /> II19 1 VAII — <br /> ( 9 ) WELL SEAL: Bottom ft * ' 03 casing � s lug , - <br /> Was surface sanitary seal provided? Yes M No ❑ If yes, to depth `1 (1 R, _ <br /> Were strait, sealed against pollution? Yes ❑ No p interval ft. — <br /> Method of sealift Work started 1B. Cnmplet J 1R_ <br /> f 10 ) WATER LEVELS : WELL DRILLER'S STATEMENT; <br /> Depth of first water, if known 44 ft Thisif was drilled der ierisdiction and this repan it true to the best of r <br /> Slmndine level after well completion 44 ft, knowledge fin :come <br /> d belief. n r <br /> wbelief. <br /> ( 11 ) WELL TESTS : SICNEIA <br /> Was well le.t mode? Yes :r Nn ❑ if yes, by whops? ( Well Driller ; <br /> Type of test Pump p Railer ❑ .air lift M `AME Wa I tPr G vitae's.�� noxi—Toa <br /> Depth fn wto <br /> ntrr rat , rt of lest ft. . At end of fest ft ( Penna, Bm,, rpar tf ) TYPed , Prin[ed) <br /> Uischaree gal/ min after�_houcs Water temperature Address R <br /> it analy,is made? Yes ❑ Na 5 If res, by whom? City 19i- nrlet ()yys gall ern a zlP 95201 <br /> ,sl 'c lou made? Yes ❑ Ne $ If Acs. attach copy ts. Ihix ropmrt License Nu. Date of this report <br /> a <br /> 188 ARE / . 1aet IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 43414.Y56 ..,a soa oawn (Dy OSP <br />