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rile WIrn WWK DEPARTMENT OF WATER RESOURCES NO. J b 1 J 4 <br /> icc,of Ititint No WATER WELL DRILLERS REPO tit it% %%till \n <br /> mut Nr) or batt Othcr 1oot_Il \n <br /> J I <br /> f .}'�VNElt � ��/�� <br /> \unt�e (12) WELL LOG Told oluOh_1_-6 t Depth of(onrpleted well�Qft <br /> 06 la±,eL^s_Mia fruln ft to ft Fn"ti itiun (Dc%trihe b% cnior Lhtraoter stye lir material) <br /> I*Mnnh Lip - <br /> ) LOCATION OF WELL — 20 <br /> - 33 clay <br /> lilt% Ua tier% «%il Nutrther <br /> it uldpvr if t1tlFereiH fr.ni ihnv _ Y pp - U sand <br /> ti.htj' li tend becnnn V sand & clay <br /> +t intt mint %tdeS Mills r uln,tuls fences i tc 101 <br /> F 01 sa],']d <br /> 101 - 111 __ clay <br /> 111 - 116 sand <br /> 116 - 119 sand & clay <br /> (3) TYPE OF WORK 1 1 - 136 clay blue <br /> New well Z Deepening; ❑ 136 - 139 sand & clay layers <br /> Reconstruction ❑ - <br /> Recrrndittoning ❑ -- <br /> Horizontal Well ❑ <br /> Destruction 0 (Describe - y <br /> destruction materials and <br /> ptrxedures in Ite-n 12) - <br /> (4) PROPOSED USE. <br /> Domesttt. X - <br /> Irrig%don ❑ - <br /> Industrial ❑ - <br /> Test W ell ❑ - <br /> Stuck ❑ - <br /> Municipal ❑ - <br /> VYFLL LOCATION SKETCH Other ❑ - <br /> UIPIIENT (B) GRAVEL PACK <br /> xx Reverse ❑ Yes-M No ❑ St ze - <br /> able ❑ Air © Diameter of bore �ry - <br /> Other ❑ Bucket ❑ Pirked froA,6Om_ _,..^._...,to-- <br /> t CASING INSTALLED (8) PERFORATIONS - <br /> ei ❑ Pli.tic 0 Concrete Li Type of perforation or size of screen - <br /> Frutn To Dia Gaffe or From To Slot - <br /> ft ft in Wall ft ft size - <br /> 119 }f 12 liq 160 Y811 - <br /> WELL SEAL Bottom ft. Of casingisug. <br /> « - <br /> as surface Sanitary seat provided" Yes M No ❑ If yes to dept ft <br /> CKcre strata sealed against polludnn" Yec No C] Interval - ft <br /> thixl A seahrl `Lurk st irted 19 C impleted 19 <br /> R t WATER LEN ELS U ELL DRILLERS ST ITEME\,T <br /> Depth of first water if know. 4 ft This well was drilled under ray itirisdiction and (hit rerinri rr true to the best of mit <br /> audios_ lesel ifter "ell loolpletunt 44 ft 1.nnicledge rind behtf <br /> 1) KNELL TESTS SIC\ED <br /> ,t% well telt nide' lest" No G it %eq by %ihom� (Well Driller, <br /> Tviie „f test Pump L' Hilder 0 -kir lift M V SME ! 4 <br /> pth t- ,voter 2t st trt tf test kt 1t end of tett ft (Person tion or cnrptrration I t T%ped or printed) <br /> i%chtr_e 60 _,illmin ttlierhours wlter temperatwe address P-0-0-'R x QQ8 <br /> +I iniiMis made' Yes ,^u No If %es b% .%bora" Citynktnn _ 7-f or-ni " -Zip 01 <br /> in, liar, mule" Ies ❑ \o If tee utiuh ct,p% to this report License No Date of this repots _ <br />' 1e9 pit/ 7 76) IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM ♦ago$�11 1 6 SOM QUADC,T 0sa <br />