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4R <br /> ' ORIGINAL o STATM OF CALIFORNIA Do not fila in <br /> THE ReSOU RCE.S AGENCY <br /> nt <br /> Ile with DWR DEPARTMENT OF WATER RESOURCES No. 216036 <br /> a at Intent No. WATER WELL DRILLERS REPORT- state well No, <br /> FI- uca]Permit No,or Date Other Wall No <br /> (1) 0Wj4ER: Nam McCamick & Baxter (12) WELL LOG: Total depth 1$3 it.Depth of completed welt X78 ,it. <br /> ' Address_;.] from it. to ft Formntinrs (DescriU by color, cbaracter. Azd or Pnaterfol) <br /> City StoQip 92(1 -_ 0 23 Fawn sand ala <br /> (2) <br /> 23 - 32 Sand <br /> L '� k3 (See instructforts?: d sv�T 4d 32 - 90 Silt & Q1a <br /> ' County Ihvner s Well Number w n <br /> Well address if different <br /> �ffrom abava 40 55 Sand, <br /> Township ..- _11V Range 6E _sectio 2 & ti f <br /> Distance from cities,roads,railroads, fences,etc. 62 *14 <br /> 14 <br /> call \ *3 <br /> Own �7 <br /> (3) TYPE OF WORK: <br /> New Well H Deepening Q ~� <br /> 'YT Reconstruction 0 <br /> Stye*i�pv attached hecondttinning ❑ <br /> Horizontal Well 11 ` <br /> Destruction © (Describe <br /> destruction rantarfals and <br /> P <br /> rocedures in Item 12t)'" <br /> (4) PROPOSED aSE1% <br /> ' Domestic ' �p �f _ �✓ 11 \ - <br /> Irrit{nfion ,;1+�'` �. ❑ \4 �> tr'ti <br /> Industrta] � <br /> Stock'- <br /> ry� <br /> ! l <br /> Munieipa <br /> WELL, LOCATION S9GTCf1 \�. potarlil�{t, a <br /> ' (5) SQUIPMENT: <br /> Rotary EX Rovers@ [l a yoz I , No Er Size.r a Ie`� ��0�'S� •�. "y <br /> Cakle C1 Air 0 P(�itrf0 of bore_ <br /> i$3 r <br /> ' Other Bucket 0Pink`Wird <br /> (7) CASING INSTALLED: '�� (8) MRFoRATio'N"S1 ti� <br /> Ilk _ l• , , <br /> Steel Plastie'I.Y �".an�rere • z Tree of PC 01 f or stile of scmon r-� i - <br /> w ♦' rb �.. <br /> t From To' --.Dia. Gage o►' Frothti `�"',To <br /> <' I�h�•ft. ft. (1, \is:. Wall #t � ft. <br /> 0 1.7 '.6`, 8 168 <br /> V <br /> 4tir * ill <br /> (9) WELL SEAL:„ <br /> Was surface sanitary turd provided? Yes(a No 0 if yes, to depeh . <br /> Wero strata scaled against pollntion? Yes a No E3 InterVa] _-ft. - <br /> ' method of eaalin Work starte 18 Cumplet•�I IB <br /> (10) WATER LEVELS: WELL, DWLLEWS STATEMENT: <br /> Depth of first water, if know ft, "ibis iuetl s r'I under my Pis roll and t i report is trnc to the bcrt of mf <br /> Standing level after well completion- _ ft, knaealed'et i IPeliaf. .] <br /> (11) WELL TESTS: t E <br /> Was well test madd� `Y s 0, .,Nd bp by whom? ell D ) <br /> Type of test Pump fi] l rtllee{] Air lift EI NAME nr <br /> Depth to watgf�gt'start,.of teat+[` "Et. ` At end of lest u (Ferrers,firm,orcorporatlork ' Pact or printed) - <br /> ischarge •,°}lynia after hou*s 4J� Water tempeenture Addxoss p <br /> 4 x10 [wire_ Zi As�'71 <br /> �mical nnalysis,madalt Yes q' r)No$ If Yes;-by wbomP City '�. p �- T <br /> ac electric Idle made? Yes [ =leu, If yps;'nttnch copy to this report Licenvo No. ata of this repo <br /> DWR 188 take i:�erf'_ IF ADOITIONAI.JSPACE= IS NF-EDaD. USE NEXT CONSECUTIVELY NUMBERED FORM <br />