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/ All 1967 <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> File with DWR (Sections 947P,7080,7481,7432,Water Cod*) �T <br /> ° 6545 <br /> t lv <br /> - i THE RESOURCES AGENCY OF CALIFORNIA 6 - �- <br /> DEPARTMENT OF WATER RESOURCES ,,�`;�Well No r �1: ` <br /> J/ Ocher Well No-Itfl( E— e <br /> (1) OWNER: (11) WELL LOG: <br /> Namez"413 LA-4d 1pz t� z <br /> l depth ft. Depth of completed well Q ft. <br /> Address Formation: Describe by color,ebaracter,liar of n Ierial,and structure <br /> 0-3 fr.to fr. <br /> (2) LOCATION OF WELL: - <br /> County � Owner's number,if lay 4 s _ <br /> u Township,Range, nd 54n 0 <br /> Distance from cines,roads,railroad.,etc. <br /> 72— az <br /> (3) TYPE OF WORK (check): <br /> New Wel=�H�mng ❑ Reconditioning ❑ Destroying ❑ O <br /> If destruction,describe material and proeedurt in Item 11. 46_ ld j fiAsa,, r <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: 1,7S-- Z <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ J- <br /> 14S- <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable s-- <br /> Other ❑ ,t_ <br /> 4- <br /> (6) CASING INSTALLED: 21 s- a <br /> s✓ STEEL: OTHER: If gravel packed +1 <br /> SINGLE ❑ DOUBLE ❑ .23.3— <br /> Gage Diameter <br /> From To or of From To <br /> ft. ft. Diam. Wall Bore ft. ft. 3.Z �� <br /> .r <br /> 24 -- 4z <br /> -- " <br /> Size of shoe or well ring:1-14A( x Sl Size of¢ravel: 3 i�— <br /> Describe joint <br /> (7) PERFORATIONS OR SCREEN: - v <br /> Type of oerf--ion or n of screen Q <br /> Perf. Rows <br /> From To per per Size D 3. <br /> fr. ft. row it. in.x in. �S ? <br /> S *4j-- 1- <br /> s <br /> Sx 4J t,3 - <br /> (8) CONSTRUCTION: S- <br /> Was a surface sanitary seal provided? Yes No ❑ To what depth ft. s <br /> Were any strata sealed against pollution? Yes No ❑ If vee,note depth of strata <br /> yr From Q ft.to ft. <br /> From C ft.to LC r— ft. Work started 19 ,Completed I9 <br /> Method of sealing WELL DRILLER'S STATEMENT: <br /> y This well was drilled under my jurisdiction and this report is trueto the best <br /> (9) WATER LEVELS: <br /> v of my knowledge and belief. C (v;1 <br /> Depth at which water was first found, if known ft. i-i^+r — 'i ,i>ss s s.vs 1 sr j, t <br /> Standing level before perforating, if known fr. NAME r <br /> Standing level after perforating and developing ft. (Peron,firm,or corporation) (Typed o pri»tr ) <br /> (10) WELL TESTS: Address <br /> test made? Yes & No ❑ If yea,by whom? <br /> gal.'min.with ft.drawdown after hes. SIGNED] r <br /> (Well s!!rr) <br /> sr Temperature of water Was a chemical analysis made? Yes ❑ No ❑ 1 <br /> �st1 �l <br /> Was electric log made of well? Yes 7] No ❑ If yes,attach copy License No, " es7Dared 19_ <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> a..s <br /> DWR 18b (REV. 9.413) $6391.95010.6030M TItiP( AOSe <br />