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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT NO. 31 <br /> Mice of Intent No. State Well No. <br /> i <br /> r Local Permit No. or Date �'/lJ�(pZ_707 h'j <br /> Other Well No. <br /> (1) OWNER: Name C (12) WELL LOG: Total depth -'r ft. Completed depth S3 ft. <br /> Address - 91i k from ft. to ft. Formation (Describe by color, character, size or material) <br /> Cityc.� z1P — 3 <br /> ELeh SO-4 <br /> (2) LOCATION OF WELL (See instructions): r — 13 <br /> CountY Tex % Joaa u; Owner's Well Number 'J — <br /> ,.0 Well address if different from above — 2 <br /> Township IJ Range Section 2 — -2<— t4 <br /> Distance from cities,roads, railroads, fenc s,etc. Z_ 3 <br /> q. <br /> ' /. <br /> — b Ark Y <br /> !1<+t� (3) TYPE OF WORK: — <br /> '� New Well X Deepening ❑ — <br /> F(e Reconstruction ❑ — <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> (v Destruction ❑ (Describe — <br /> d /�� '7 destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED USE-:_.. _ <br /> ` Domestic <br /> Irrigation <br /> �`�', Industrial /f�:� ❑ ��, Z. <br /> 1 Test Well �� ❑ <br /> Mtu�nicipa^] ❑ <br /> / 'er <br /> y WELL LOCATION SKETCH / e, ibe) <br /> (5) EQUIPMENT: GRAVEL\'Y��ACK: <br /> Rotary ❑ Reverse 13NotiSize <br /> Cable ❑ Air ❑ <br /> V <br /> Other Bucke�,�Q om _ <br /> (7) CASING INSTALLED: (8) PEATI _ <br /> steel ❑ Plastic n Typ�ofuF'o"�Yon or size of �i.� <br /> FromTh Di Gage or <br /> ft. f Wall <br /> 2S b, ty - <br /> �. \: <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes I No ❑ if yes,to depth 13 ft. <br /> Were strata sealed against pollution? Yes 7iL No ❑ Interval ft. — <br /> Method of sealing % A Work started 19M Completed 19 <br /> —0) W ATER LEVELS: WELL DRILLER' STATEMENT: <br /> Depth of first water,if known .J�ft. <br /> Blandin level afterwellmm completion��•��ft This well was drilled under my jurisdiction and this report is true to the <br /> Standing P best of my kaat4ledge ief. <br /> f 11) WELL TESTS: Signed <br /> 69L <br /> well tat made? Yes ❑ No ❑ If yes,by whom? ( I ri11 ` I <br /> of test Pump El Bailer C3 Air lift C3 NAME <br /> i to water at start of tat ft. At end of test ft. erson,f' ,Sr corporation)(Ty pr' ted) <br /> r. harge gal/min after hours Water temperatureAddress <br /> Chemical analysis made? Yes ❑ No ❑ If yes,by whom? City ZIP <br /> Was electric log made Ya ElNo ElIf yes attach copy to this report License No.- 1 <br /> U_Z"P Dnteof this report 10 <br /> DWR 188(REV. 12-88) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br /> V <br />