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6EC 1JaJ <br /> ii oRlclrlar WATER WELL DRILLERS REPORT Do Not 17311 In <br /> Fila wills DWR (Saatiom 7079, 7020, 7081, roe:, Water Code) <br /> THE RESOURCES AGENCY OF CALIFORNIA No 44213 <br /> a DEPARTMENT OF WATER RESOURCES Stare wevxa <br /> 0<�. Y/ Other Well Nom; <br /> ( 1 ) OWNER: ( 11 ) WELL LOG: IN /t@r — 1 <br /> Name Tod depth it. Depth of completed wall ft. <br /> Address J Formation, Dex"I by cal", character, the of material, end inaction <br /> 5. re. m ft. <br /> (2 ) LO ATION OF WEL : <br /> County lmem� Owner's number. a any _ V <br /> Towmhip. Rangeand SeXonA _ <br /> D'utance from oiler, raids, dlaaada, etc. S—_ <br /> P - 8u <br /> (3 ) TYPE OF WORK (check) : 96 , <br /> New Well 10 Deepening 0 Reconditioning ❑ Destroying ❑ D <br /> If datnaelion, describe material and procedure in Item 11, 41 F <br /> (4) PROPOSED USE (check) : ( S ) EQUIPMENT: .2 .. /3 . <br /> j Domestic Industrial ❑ Municipal ❑ Rotary ❑ � <br /> Irrigation Test Well ❑ Other ❑ Cable �5( 2 — ( z <br /> Other _ <br /> (6 ) CASING INSTALLED : Rg_ p - d <br /> STEEL: OTHER: If gravel packed 0 <br /> SINGLE l] DOUBLE [] <br /> Gage Diameter <br /> From TO or of From To <br /> It, ft. Dian. wall Bore fO ft. <br /> U �,31 8 !o <br /> .AL <br /> Size of shoe or well tin 71C ( Size of gvvel: <br /> Describe joint Q q 14 (dl e. l d ' <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perfovrlo"In or name of ad em Ai I LL Is P h s <br /> Ferf. Rows <br /> From To per per Size <br /> ft, fr. row fc. <br /> S � ,n. X2. <br /> UUNVIVWNTAL LOU <br /> ?:'atsa rJDrae �, r�9 tOrO <br /> (8 ) CONSTRUCTION: <br /> was a aurfaee .anitary red provided? Yea 0 No 0 To whir depth it. <br /> Were any stran sealed agalauc pollution? Yet ❑ No 0 If yer, note depth of vrata <br /> From ft. to ir. / p <br /> From it. an (r, , l Work meted 19 1A Completed 19 <br /> Method oFedmg WELL DRILLER'SI STATEMENT: <br /> (9) WATER LEVELS: This well war drilled under my furisdirtion and this report is trite to the bat <br /> Depth at which water an fine found, If known it, of my knowledge and belief. <br /> Standing level before pedondag, if known m. NAME VALLEY VVAfE; <br /> Standing level after perlantle2 and dnelo ins h, (Puson, &m, ar wtepntLoa) (T1Prd ar trinted) <br /> ( 10) WELL TESTS: Address Da <br /> p the made? Yn ❑ No ❑ H yet, by whom? <br /> �Y ` 2al.tmin. with fr. dnwdown after hv. <br /> [SIGNED] <br /> Terisy<niure of water Wvaehemi,al anaiYais mad,) Yv ❑ Na ❑ & en DnBrr) <br /> Was electric log made of well? Yn 0 No 0 If yes, attach copy Lieenee No- 191 503 Hated <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 enEY. 9.e31 <br /> 39391.9eo m-m Sows IRlp0002r <br />