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Un a STATE OF CALIFORNIA <br /> =nayiTHE RESOURCES AGENCY Do not in <br /> DEPARTMENT OF WATER RESOURCES <br /> _ No. 197559 <br /> 1111,de.,f intent a,.. - -- -- WATER WELL DRILLERS REPORT <br /> L,c;d Ycm,it 10. or D:de_ � tiRte <br /> - Uther W01 \- . _� ---- ---- <br /> -- <br /> (1) OWNER: pan„•-TDIIl–iil(i�—Qo�n------- _----- �12) WELL LOG: <br /> Address—--2l �j p'�,�},�� 'Tobd depthl�_ft Depth of(•un+pletcd well-1 <br /> �- aLlrZlill�. a�u'--- fnnn ft. t�, F. I ^s-'�ft- <br /> r j� t Fonnatior+ Ih•�eri 1>e by a+lur, char.+eter• size or materi.d <br /> 953 <br /> (2) LOCATION OF WELL LL (yinstntctions): <br /> County__S•g�,_,j _Ow-ner's Well Number ___ �- <br /> -ell address if different fnnn nl>ove _ 2 `, <br /> ',wnship _-- -- drown elay <br /> .__Range Section 72 - 36 — r ane b <br /> istance frim cities, roads, railroads,fences,etc _ •awn sand <br /> sand <br /> r _C.7 gy brow <br /> nrl <br /> I (3) TYPE OF WORK: I - n <br /> New WeBX] Deepening ❑ <br /> Reconstrudum ❑ _ <br /> Reconditioning ❑ <br /> Horizontal Well 72 CI <br /> ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and <br /> Procedures in Item 12);` <br /> (-f) PROPOSED USE7' - <br /> Domestic1617 iVate •.,• _ _ <br /> irrigation . ❑ .._ L_ <br /> Industrial ❑ - <br /> Test Well ❑ <br /> Stock- <br /> Municipal <br /> tock Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ _ <br /> (.51 EQUIPMENT: (6) GRAM I:L'PACK: _ <br /> hotaqReverse ❑ Ye} <br /> IQ No ❑ Size <br /> Cable ❑- air ❑ .611peter of frore.__. <br /> Other ❑ Bucket ❑ Packed'fiom �f (-' <br /> as to"fit. - <br /> r <br /> f7) CASING INSTALLED: - (fl) PERFORATE S1tS: r• ru <br /> Steel El C,—rete El Type of perfpfpitiba or size of screen. _ ___y ROM D4T11�HEA4TFf <br /> FERMII SERVICER <br /> From To Dia. Gaffe-or From To Slot - =C <br /> ft. ft. in. Wall ft. ft. size _ <br /> —0- <br /> Of WELL SEAL: _ <br /> I <br /> Was surface sanitary seal provided? 1'es�] No ❑ If yes, to depth_�_ft. <br /> Were trate sealed against pollution.' Yes C1 NI. ❑ Interval_ _.ft. - <br /> Method of seatingWork started 19 Completed19 <br /> 1. <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known_____ ft. This well wag drilled under m, <br /> Standing level offer well completion— ft. knareledge and belief. 1 ftrrisdiction and this repnrr is fore to the best of mil <br /> (11) WELL TESTS: <br /> Was well test made? }'es ❑ No ❑ If yes• by whom? (Well Driller) I <br /> Type of test Pump ❑ Bailer ❑ Air lift <br /> ❑ NAME <br /> Depth b> water at start of test _ft. At end of test ft arson, rm,or corporao" ur p t <br /> eM <br /> Discharge eal/min after hours Water temperature Address 300 S-(il roy i <br /> Chemical analysis made? 1'es ❑ N+, ❑ If yes, by whom? City'_ furl ocko CA 1 4 1! zip 9538n <br /> Nal electric log made? Yes ❑ No ❑ If yes, attach ropy to this report License Nn- ate of this rep> I <br /> DWR tae (REV 7.781 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM _ <br /> t <br />