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®lt1�INAL* STATE OFCALIFDRNIA Do not rfZl to <br /> ' THE RESOURCES AGENCYc <br /> Me with DWR DEPARTMENT OF WATER RESOURCES HiQ. r�}}L 16 3 6 I7 <br /> owc <br /> of intent No WATER WELL DRILLERS REPORT State Well.Io:' Permit No.or Dato B-26-87 (������ j y� y�.j 1:t Other Well Np.— <br /> (1) ClWNER: Nnma_. '1cCk? jck & (12) WELL LOG: Tom depth 173{t,Depth of completed%veli 173ft. <br /> ' Adtlross; _ _ 2 from ft to ft. Fonnation (Describe by color, chnrncter, size or matorial) <br /> Cl tr Sto!; �n, CA_ 7jp 952()1 0 - 8 Gray silty fill <br /> (2) LOCATION QF" WELL (See instructiotis): 8 3 Brown sandy sa. t <br /> County aqD 4Q3C uIl _Owners Well Number a5W 2d <br /> 24 2and <br /> Wo11 address if diff,.,From abn �WaS�l]17 OT1 ST = <br /> Towmhfp_ Annge 6E Secte \� <br /> Distance From cities,roods, railroads,fences,etc <br /> 35 .Coars sand <br /> 5 - 173 etz era silt & fmne sand <br /> (3) TYPE OF WORK: /1-1 <br /> ' New Wall (R Deepening❑ <br /> llecanstrudiOu ❑ — `�''t-. <br /> Reconditioning C1 <br /> ' <br /> Horizontal Well ❑ <br /> See imp attached Destruction q {Describe <br /> destruction materials and <br /> procedures in Item 12 — 1j.. <br /> (4) PROPOSED Cl41 <br /> ' Domestic Q�• — <br /> Irrigation ❑ `� <br /> Industrial ❑ <br /> Stock t <br /> v v <br /> hiuniclpal� ❑ w% !1 '� <br /> WELL LOCATION MTCH the — k <br /> ' (5) EQU)Phl);NT: (S) GItAVE�L`S1- CSe N :n ^ <br /> Rotaryf IIEVCFSe [a ire ❑ Size ",. <br /> Cahle Q Air ❑ *Di;hn t�x of bora <br /> �^ <br /> Other Q'(t< Duckef ❑ Packed frarr`� t-1143--ft(; ,\:'\M — <br /> ' (7) CASING 1NSTALLEf)t �( � (8) PERFOIEATf N — <br /> Steel$J fIOrtle u Conrrata Q,.'s Type of perfo ab for%i of screen <br /> From To G.�oir' Fro ��a �`��ycioh� — <br /> ' fL it. !� :n, W.111 <br /> ft. '�1; ft t �,slzc� <br /> D - <br /> 173'c .5. .2 0 156 173 ,� <br /> (9) WELL SEAL: 3 <br /> Was surface sanitary seal provided? Yes$i No Q If yes,to dep1LL54_—jt. <br /> Were strata sealed against pollution? Yes ❑ No 0 Interval ft. <br /> ' Method of staling Work started -M — 19 Complete 19 <br /> (10) WATER LEVELS: WELL DIALLER'S STATEMENT: <br /> Depth of fiat %rater, if knew " h- Thin melt tt:csrdr Ind urlaer my in isdfctiun and this report is true to the but at inp <br /> Standing leyel after Woll-conpletio t. knowIedge an b fe). <br /> ' (I1) WDLL• TESTS: SzcNr n <br /> Was w �test Ingle? Yes 6 N m <br /> TF yes,by who ? I (W taller) <br /> Type pP testPump cy '- 1l Hager ❑ Air lift E] NAME <br /> 13ept!-ta~wlter 7tt start of test, ft. At end of test (Person,firm,or corporation) ( ypecl or printed) <br /> ' ��Ls�' rallmip,nfter_ r' -i -hours FVatex tamperatur Address_ �(��j_�j����lm� � a <br /> [,n <br /> tniq?dy .• Nayl�jF ycs. by whom2 City P31 ('Pr�Yd {'A zap 73 <br /> ectrip idl:'mnde7' X'es ❑ No tf yes, ntiach copy to This rcpott License No.�514a�_ Date of this report_ <br /> DWR lbe,{�rv.�:.sa) ir..'ADDf IOIi AL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMOERED FORM <br /> Cal <br />