Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA DO HOE fill In <br /> THE RESOURCES AGENCY <br /> Pilo with DWR DEPARTMENT OF WATER RESOURCES No . 096685 <br /> , . .f Intent Nn. WATER WELL DRILLERS REPORT Shite Well No, <br /> Lt . ,u PannEt No. at Dale Other Well No.OI.�O_ 1491 a <br /> ( 1 ) OWNER ; NorteL 1 C I ( 12 ) ' WELL LOG : p h /7 Don ,.f e, <br /> 1 Total Jet , Depth completed welL__Y`f-If. <br /> :lddresp / L.YL. ' / ) from R. to It, fromiation ( Dee be by color, uharoeter, sizematerial ) <br /> :Ih• n _ <br /> Zit y �J <br /> ( 2 ) I�O� 1TI F WELT <br /> ( See instructions ) ; ..� , <br /> t%osw . GLr Car r Yell Number <br /> Wel ire If dill an ro have <br /> •losanile actio ') <br /> Dista ons from cities, ds, milnutds, fences, are, — <br /> L <br /> ( 3 ) TYPE OF WORKi - / <br /> No WeLL Deepening ❑ <br /> Reconstruction ❑ <br /> Reconditioning ❑ � •` — _ y.\. i <br /> Horizontal Well ❑ �, ,� — 11 r <br /> Dmtmctlon El (Describe <br /> — <br /> destructlna materials and <br /> Procedures in Item 12)-' <br /> i \++ <br /> ( 4 ) PROPOSED USEr - <br /> Domestic <br /> Irrigation ❑ _ <br /> In Industrial ❑ <br /> `e( ft �^ Test Well ❑ _ <br /> X , I ISbQ Stock ❑ — <br /> Municipal ❑ — <br /> WELL LOCATION SKETCH I' Other ❑ <br /> ( 5 ) EQU1Ph/1ENTi ( 8 ) GRAVEL PACK: — <br /> Rotary B" Reverse ❑ Yes W/� Na ❑ Siz — <br /> Cnhie ❑ Air ❑ Diameter of bore—.4 — <br /> Other ❑ Bucket n Parked from to / R. — <br /> M CASING INSTALLEDt - ( 8 ) PERFORATIONS: - — <br /> Steel ❑ Plastic Concrete ❑ Type of perforation or size of semen — <br /> From - To Dia. Gage or From. F TO Slot — <br /> ft, ft, in. Wall ft& ft. size — <br /> ( 9 ) WELL SEALI -:i <br /> Was surface sanitary seal provided? Yes (y' No j?rlf yes, to deplhSZ:t ft. —Were strata scaled aga Vol Y " ;�—y/ No f; Interval ft. — <br /> Method of sea LLn n' Wt A starte Completed 19�. <br /> ( 10 ) WATER LEVELSt WELL DRILLE STATEMENT : <br /> Depth at got water, If know� ft. qor mu lur/ad tfe/i and this nod It nuc m the bent of coil <br /> This well r( dun <br /> Standing level after wall completion ft. knosaladga an t 1 . <br /> ( 11 ) WELL TESTSI SIGNED Gi' fb"�'� <br /> Was well test ,nide? Yes C No Yes, by whom? ( Welt Driller ) , <br /> Type of tort Pump C Bailer ❑ Air IIR ❑ NAbIE i CC <br /> Depth to water at start of test IL At end of test ft • �'• ^ 3 G k,tdd 300 50 <br /> 'lusrgn gal/min after h/ Water temperature <br /> Address • • '" s , - - <br /> As <br /> .uleal analysis made? Yes ❑ No 9' yes, by wham? <br /> Cih' n ��/ a � iP <br /> Was electric Ins; made? Yes ❑ No If Yes, attach copy to thi.v report Lioense N I s_D to of thf9;repn " jr <br /> DWR lee Ipev. vvm IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED-P001r1t ' Y", <br />