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4 <br /> K J <br /> ORIGINAL STATE OF CALtFORNIA <br /> Dv not fill in <br /> THE RESOURCES AGENCY <br /> He wil <br /> Intent Noth DWR DEPARTMENT OF' WATER RESOURCES NO, 1976084, 3 <br /> NATER 'WELL .DRILLERS REPORT State Well Na � ��/{� �' � <br /> � � <br /> �" _"_ � <br /> L o;oe.l.acn �en'.st No.or bate Other Well Na <br /> (1) OWNER: Nam, MCCLEAICJL ± BAX164—_ (12) WELL LOG: Total d@nth e,�e � _It. <br /> Address- 17-14Lfr7 _,•, From it to R. Fotmndon (Describe by color, charseter, she or matedaI) <br /> City—_ ip <br /> (2) LOCATS N OF WELL (See instructions): <br /> County. 1 )Aaj1I�J Owners Well Number. <br /> ' Well address If different from ahov <br /> �lV <br /> �yy ' O ` J o M <br /> Township _�-- Flange (E�� —Section <br /> Distance From cities,roads,milronds,fences,etc 1=0 <br /> ` F' —N�ojV <br /> (3) TYPE OF 'WO1i1C: leg MC> <br /> New Well Deepening y <br /> Reennstruction © - '�'�"- <br /> O � ! <br /> Racandi#inning ❑ .- -- �' <br /> Oxy <br /> f Iiodzcntal Wel! 11 <br /> i Dertrucdon 11 (Desen'ba <br /> 1 destruction materials art <br /> procedures la]tem L2 1� _ <br /> ( ) PitOPC)sE7� r� \♦� f <br /> Domestic ✓ <br /> led 61O&t J1��0� IrrtgaHon ❑ � � v <br /> Industrial ❑ <br /> Mugigi�pti :s: �rt -f1 <br /> y WELL LOCATION SKETCH oeher t'tU1r3�r4' l',�ttz yet v �`-�_ \� <br /> (5) EQUIPMENT-. I GRAV CKs <br /> Rotary ❑ Reverse ❑ ` Nc Sixe <br /> i10 <br /> cable Q Air ❑ \ e}nn�ar of bore <br /> s Othar ��� Bucket ❑ ed am <br /> (7) CASING INSTALLED: ^ (A)-iERF'ORATI.°, -v <br /> < <br /> Steal plasticElCe C ke Type of pe dry on at ze of scree - <br /> �.! e t K <br /> From To Diu. Cat- r Frbxri� To <br /> Wn7E <br /> y\ v <br /> r� `t5Z 'ft-TVt4 vp" <br /> ` Yip.♦ 'v <br /> M (9) WELL SEALt s <br /> '-.' Was surface sanitary seal provided? Yes No ❑ If yes,to dept fl W Zc <br /> y7 <br /> Were strata sealed age t polluHan? Ycs ❑ No CI Interval ft. <br /> Methad: of seatut Work start <br /> ' (10) WATER LEVELS: WELL DFdLLER'S STATEMENT. <br /> Vie• I)cpth of first water, if known it, This wall drilled antler my ]r 'diction and this report tr true to the best of my <br /> Stand xutt loyal after well completion (t, knotoledg¢ r lief <br /> F" (11) VVELL TESTS: SIONZD ' <br /> Wes well test made? Yes No Q If yes, by whom? [ ?}� ;g (well rilirr) <br /> F:+'F Type of test Pump 8n[ler Cl Air lift❑ NAME+. <br /> ^ Depth to water at start of test C At end of tear k (Person firm,or corpn7aHon ,( ped or printed) <br /> barge nal/mfa after hours Water te`mpeerature Address <br /> CA <br /> '- , r Mcal analysis made? Ycs 4 No p If yes, by whom? <br /> �I"IG�j f.�... City ' <br /> Was a]ectric lair m¢dc7 Yes ❑ Na 1iIf yes,attach copy to this report License No nate of this repa.r <br /> oWl; tag tttsv.y-let IF ADDITIONAL SPACE; IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> sr ' <br />