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--- <br /> DEC2 7 � <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Pill In <br /> Ella with DWR (Sectioua 7074,7080,7091,7092,Weer Code) <br /> () <br /> 47,596 <br /> THE RESOURCES AGENCY OF CALIFORNIA ;� I'\ w-` <br /> DEPARTMENT OF WATER RESOURCES State Well No <br /> .., c <br /> Other Well No <br /> (1) OWNER: (11) WELL LOG: 3 <br /> Name xTotal depth 13 <br /> 1 fr. Dcpch of completed well J 7 fr. <br /> Address �Z"j_ Formation: Deeeribe by color,characler,els of nsaterial,and rlruelure <br /> G,,, ?F• n — ft.to 4ZILl ft. <br /> (2) LOCATION OF LL: <br /> County 0- a number,if any �] .Z <br /> Tosvnship,R.nw Ran ,and ction - <br /> Distancc from cities,roads,railroads,etc. / I 77 <br /> J 2— <br /> (3) TYPE OF WORK (check): <br /> New Well N Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: <br /> Domestic [4 Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLE ❑ DOUBLE ❑ <br /> Gage Diameter <br /> From To or of From To <br /> fc- ft. Diam. Will Bore ft. fc. <br /> ,::•.res <br /> :=rte <br /> l 4l?i i.� w- <br /> Size of shoe or wall ring: LoSize of gra-1: <br /> Describe joint <br /> (7) PERFORATIO OR SCREEN: <br /> Type of perfora rion or name of screen <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft_ in,x in. <br /> (s) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes ❑ No To what depth fr. <br /> Were any Strata sealed against pollution? Yes ® No[J If yes, or.depth of strata <br /> From fc. m r } ft. <br /> From fr. to fr. Work started 19 L^^cs ,Complered l 19 <br /> Methad of sealing 09q Jf _/. ter/ 41-2 �, L�S IIYC>- WELL DRILLER'S STATEMENT: <br /> (9} WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> of my knowledge and belief. <br /> Depth at which water was first found, if known ft. <br /> Standing level hdare perforrrng, if known ft. NAME vAl Cy 1ln,ra _� `I!`4L DR�1 UNG <br /> a at �I, <br /> Sc2nd;ng level after perforating and developing ft. (person,firm,or corporation) (Typed or printed} <br /> L10} WELL TESTS: Address f� "�'7 7 <br /> �1 p rest made? Yes ❑ No Cl If yes,by whom? <br /> Ral.lmin-with ft.dr—dawn after hrr. [SIGNED] Is . <br /> (Well Driller) <br /> Temperature of waar Wee a chemical analysis made? Yea O No ❑ ) /� <br /> Was electric log made of veil? Yes ❑ No Cl If yet,atueh copy License Noy! ` n2tec4 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE w <br /> DWR 108 (REV. 9-4131 110301-05o+o-er ISOM TH+r a•r <br />