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THE RESOURCES AGENCY <br /> ORIGINAL iPARTMENT OF WATER RESOUF- �S N° 98907 <br /> File with DWIt State Well No <br /> WATER WELL DRILLERS REPORT <br /> Other Well No -_2-221 W <br /> U OWNER (1 1) WELL LOG: <br /> Ills Total d,pth15 1 fE Dtr,h if�omplet,d will ft <br /> AddressRohi Averormanon Drsersbe by solar rbnarier si-e of maerrral and i1rerture <br /> ~ it 1. [E <br /> (2) LOCATION OF WELL 0-4 _T012 C;0il <br /> ' Lounev Uwner s number if any Zqhale <br /> sp <br /> rownih1tan, and Section _ <br /> Uutance frumuEses roads ratlraads CCCLintters Rd & Frontage "^ <br /> (3) TYPE OF WORK (check) of Roth Rd. <br /> New Well fd Deepening ❑ Reconditioning ❑ Destroying ❑ 4.5-53 Rnrid—fair <br /> ff destruction,deserrbe materml and procedure i»Item I t <br /> ' (4) PROPOSED USE (check): (S) EQUIPMENT; ii e C <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well 0 Other ❑ Cable ❑ <br /> 69-73 Sal3L-- <br /> Other ❑ _� <br /> ' (6) CASING INSTALLED <br /> STEEL X OTHER If gravel packed _ <br /> SINGLE 2 DOUBLE <br /> ' Gage Diameter 3 <br /> Sq nej <br /> From to or of From To <br /> ft it Diarn Wall Bore it ft 07 <br /> l r. <br /> r�!,hue�r well nnxy Size of Rravel <br /> fib!1UIRt we <br /> 1 <br /> PERFORATIONS OR SCREEN. <br /> T of permfinun 9r name of screenq1 nt. <br /> ' Perf Rows <br /> brunt To per per Size <br /> tt it row ft in x in <br /> is <br /> ' (I1) CONSTRUCTION <br /> VPas a surtase amttiry mal provided) Yes No ❑ To what depth ft <br /> ' Were my,tnta scaled against pollution? Yee ❑ No ❑ IF its note depth of strata � <br /> i <br /> Krum fE to it <br /> From it w it VoA,tarr,d _6 19 !L Ctrmplcted 19 <br /> 41rEhw!of catine _BentorLLte WELL DRILLER'$ STATEMENT <br /> (9) WATER LEVELS This well was J,dlfd ander my tunsdtetton and lhrt report is true to thr btst <br /> of my knowledge and belief <br /> Uepth at which water was hat found if known [r <br /> ltindinq te,el 1leture pertoratinK it known ft NAMrHenninzrs Bros. anirillin Co• jnC <br /> {Person firm,or corporation} fT)ped or pra.trd) <br /> 3 undinq I,srk afar prrfura nap ant] Jet elo ing is <br /> (10) WELL TESTS Address 21M0W RLiMble Rd. <br /> as pump test made? Yes ❑ No If yes by whom[ 0 <br /> ' J ital [min itch it drawdown after hrs [SEGNED] J <br /> rmpen cure s1 ranee was 3 chemical analvut made) Yes ❑ No 11 <br /> nr (Well DtrlliI LG <br /> s rlaclsi� tuti made et well? Yrs I❑ M,2 it yes attach copy LILCrUC NO... �"+nR� � Dated <br /> SKETCH LOCATION OF WELL. ON REVERSE SIDE <br /> r 4.� <br /> ()WR t88 (REV 9 691 261799`509 6.SOm YR1P Lo OSP <br />