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a <br /> ' <br /> GYATS OF CALIFORNIA ORIGINAL Do not add in <br /> THE RESOURCES AGENCY r� <br /> File with DWF! DEPARTMENT OF'WATER RESOURCES No. G 16323 <br /> ca of Intent No. WATER WELL DRILLERS REPORT stare Well No. 1 { <br /> aI Perm]':Na.or Dote 7-87 Other Well Oa No 6g vow <br /> (1) OW14ER: Nam /�2M Hill. (12) WELL LOG: Total depth�U+ft.Depth of complated w '� s?� <br /> ,,�y et�c..,ft. <br /> ' Addtess — 700 PC]]�leU St fmm ft. to ft Formation (Desenbe by color, chamctcr, size or material) <br /> CiCA ip 94608 0 - 10 Fill <br /> ��� 10 - 33 Brawn sap silt & C� <br /> (2) 1,� DF WELL (See instructions): DS�n7 33 r 44 Green 8 <br /> County Owner's Well Number =d ala. <br /> ' Well address if dillere t from abov ~ 44 — 54 Sand <br /> Tawnsttip_ 1(ango Secfton __ 54 — 75 Green sandy�� It & ay <br /> Distanco from cities,roads,railronds,fences,ctc O 5'E� Sall <br /> ' 8T-- 90 s t, ` ay & Sarld <br /> (3) TYPE OF WOIRIG 7? <br /> ' New SVell 0 Deepening p T <br /> Reconstruction El .� <br /> See Map Attached Reconditioning <br /> ' Horizontal Well <br /> Destruction EI (Describe <br /> destnrotian mnterials an t <br /> procedures in Item IS <br /> (4) PROPOSED US1�� a <br /> ' <br /> Domestic <br /> irrigation ❑ <br /> \\_1 <br /> industrial , ❑ <br /> Testi ell ❑ <br /> StagMunlclpal [] v` <br /> NYELL LOCATION *IKETC11 '\\ IheT , <br /> ' (a^) .EQUIPMENTt (0) GRAVE'>:-PI K.. <br /> Rotary xq Reverse Cl 81R No Ea Size A (�n'r% <br /> Coble 0 Air ❑ ))i�';� f bo `)�� �� <br /> �x t <br /> ' Other I,d Rucker ❑ F6Z i!c1;TrAt��to <br /> (7) CASING INSTALLED, [ (8) .P RFORAT <br /> Steel cax Ptaskic ❑ C.01t 1 f`�;, Type of perfo lr4� th r_s tet of screen <br /> Froth To �{ 9Vr,Tile. Oag�'or' T?rd <br /> ft. ft. '("4n' Wall ft 'j ft. z�� <br /> ' 0 8'7'0,5,.8 77 87 <br /> ' (9) WELL SEAL: �� — <br /> Was surfnea sanitary seal provided? YeM No ❑ If yes, to depth-7,jet. <br /> Nese strata sealed agalest pollution? Yes ❑ No C) Interval.-- rt. <br /> ' hfeWod of seattn Work started- .19— Con <br /> — 9 <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT- t <br /> Depth of first +enter, if known T ft This tuel( ruas drilled undar my jar rlrwI this report Ile.to the best of m <br /> StandO+y,lavet atter wail campketion f; knowledge pad ef. <br /> (11) WELL TESTS- Slci r DC)Ao CO <br /> Was well teat made? : Yes p No ER If yes, by whom? 1VF1 p3140 r} <br /> Type of test Pump ❑ Bailer❑ Air lift 0 NAME Diawnd C e liiIg C. <br /> Depth to water)) stptf of tear,_., �ft. At end of test s is vn,ar CDT=) (Typed or printed) <br /> Addtos1 3.05 �E<tlailla 'Lar1e -- <br /> ' ischarge-- after hours Water temperatw PaiO C Or CA <br /> C. <br /> ntidtysis triade?- Yes ❑ No$ If"Yes, by wbom? Ciry t <br /> nleeI&log made? Yes © No R If yes,attach copy to this report License No. 5124M; Date of this report <br /> DWR 188 (NEV.r.M IFADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 . <br />