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C STATE OF CAL1FORN1A Do Not Fill in <br /> ORIGINAL THE RESOURCES AGENCY <br /> lrlr <br /> Fits with DWS^-' ,1..�:',�7 J DEPARTMENT OF WATER RESOURCES N° 142008 <br /> WATER WELL DRILLERS REPORT State Well No.'7A11,8 1d <br /> Ocher Well No. <br /> (I) OWNER: (1 1) WELL LOG: <br /> tV an]t: Total depth fr. Depth of cmupleeed well fr. <br /> Address Formation; Dnrribe by rotor,rhararter,rise of material,and rtruchsre <br /> k.to ft. <br /> (2) LOCATION OF WELL: uanrj <br /> 4ounty Owner's number,if anv <br /> rownship.Range,and Section <br /> Distance from cities, roads,railroads,etc. <br /> (3) TYPE OF WORK (check): _ <br /> New Well EX Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destrsctiwi,,describe material,and procedure in Item 11. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic [j Industrial ❑ Municipal ❑ Rotary ] c <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br />' <br /> If gravel packed 1 e <br /> STEEL; OTHER: <br /> SINGLE ❑ DOUBLE ❑ jr— HEM <br /> Gage Diameter <br /> Froin ru or ofFrom `I'o <br /> fc. ft. Diarn. Wall Bore ft. ft. ILle <br /> S-e of Ace ar well ring: Sire of¢ravel: <br /> Describe i.,int RPURH <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of pestoraliun or name of screen <br /> Perf. Rows <br /> From To per per Size <br /> fr. ft, row ft_ in.x in. <br /> (S) CONSTRUCTION: <br /> Wu a surface sanitary seal provided? Yes ❑ No ❑ To what depth it. <br /> Were any s Baled againsr pollution? Ycs ❑ No ❑ If res•note depth of strata <br /> Frurn fc. to fr. r r7 r� <br /> Crum r7❑fc. to fr. Work s,.rI,d —16 19 ! ,Completed 4-20 r7 19 /6 <br /> Mrrhod of.rating r WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled wtiler my Jurisdiction and this report is trite to the, best <br /> of my knowledge and belief. <br /> Uepch at which warce wis fisc found, if known <br /> Standing 1.•vrl before perforating, if known fr. NAME <br /> )[winding level afi- perforating and developing fr, (Pert f7f Dept idh) STyped or printed) <br /> (10) WELL TESTS: Address 5939 E. Fremont <br /> pump I—made? Yea Lf No ❑ if yes,by whom? D ri 1 I er _ i <br /> d: 12 <br /> gal.fmin.wnh ft.drawdown after he,. [SIGNED] <br /> fWr!(Dri flet) <br /> remperuure of water Waa a chemical ao4lysir made? Yrs ❑ ❑No 2007941� <br /> Wae electric log made of w11? Yes ❑ No ED If yes,attach copy License No. Dater} 4 2 0 , 1.97 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE _ �a—, 14 <br /> ON1rR 188 (REV- 9.4131 19�� - f 1�1•7a]ON T111r Or Osr <br />