Laserfiche WebLink
STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br />` File with DWR bEPARTNIENT 01= WATER REsouRCE <br /> WATER WELL DRILLERS REPORT N0. 252922 <br /> it( of intent No Statt.Well No <br /> ..Kal Pt rout No or Date. AA- _ Other Well No d49 <br /> OWNER (Naini (12) WELL. LOC Total depth JZ ft Completed depth-12 5 ft <br /> Addr"cti from ft to ft Formation(Describe br color character size or material) <br /> (qty ZIP <br /> (2) LOCATION OF WELL (See instructions) 3 — 5 <br /> County Owner s WWII Number <br /> Wt 11 address if different from above i5 - 2 0 <br /> Township Range Section 2n 4Q Clay <br /> - <br /> Dtslant.e from uties, roads r iilruads fences etc ra 0 QI <br /> east SjdQ ill — . 118 <br /> r� <br /> 118 — 170 Clay <br /> (3) TYPE OF WORK - <br /> New Well fX Deepening ❑ <br /> n <br /> Reconstruction ❑ <br /> ' Reconditioning ❑ - <br /> Horizontal Well ❑ _ <br /> Destruction ❑ (Describe - i' <br /> destruction materials and pro- 1, <br /> ' cedures to Item 12) <br /> (4) PROPOSED USI�Z <br /> Domestic <br /> ' Irrigation ,' W <br /> industrial / .......... ❑ <br /> ♦ <br /> Test Well ♦ ; } ❑ _ <br /> Muntcipul ` �/ ❑ _ <br /> Other ❑ <br /> WELL LOCATION SKETCH 1(Dj <br /> ri�) - <br /> (5) EQUIPMENT �5) GRAVEL PACK Sand - - <br /> Rotary fx Reverse ❑ Yes No El Size 1 — <br /> _ ll <br /> Cable ❑ Air ❑ Diameter of bore <br /> Other <br /> ❑ Bucket_ ❑ Packed from 7.p^^to 1 25 �Ft <br /> (7) CASING INSTALLED S (8) PERFORATIONS _ — <br /> Steel ❑ Plastic U Lonerete ❑ Type-of perforation or size of screen _ <br /> From To ,_ bia. Gage or Prom To SJot = <br /> ft ft ill 1 Wall ft- ' ft -'size <br /> 0 125 160 1051125"> `Scree <br /> (9) WELL SEAL <br /> Was surface sanitary scat provided? Yes No ❑ if yes,to depth_. _ft. <br /> 'Were strata scaled against pollution? Yrs ❑ No ❑ Interval fl <br /> Method of sealing RENIONTIE Work started- Fah 2 19_ a$ Completed 19— <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Deptliof first water if known ft <br /> This well was dri!!cd under my )urisdtctton and this report it true to the <br /> 'Standing level after well complettun - -25 ft. best of niy knowli da-an belief <br /> (11) WELL TESTS <br /> est made Yrs Signed <br /> Was well t <br /> ❑ No �] If yes,by whom p (Well Driller) <br /> le of test Pump ❑ Bailer ❑ Air lift ❑ NAbII- H E N I N G S B R O S , I)RT I I, TMS r, I_l�.C_„ <br /> h to water al start of lest ft At end of test ft (Person,firm ur cuELA r ration)(Typed ur printed) <br /> AVE- <br /> dharge gal/min after hours Watertemperature Address <br /> eal analysis made? Yes Cl No KI If tics U)%vlwm' City �R S T O ,CA 71P 96366 <br /> ' as dectnc log made Yes ❑ No 10 If ym attach cops to this report 1 Igen%e No Date of this report 4AR 4 88 <br /> DWR 188 (REV 12-ee1 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NVM13ERED FORM 06 96353 <br />