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ORJGINAL WATER WELL DRILLERS REPORT Do Not Frll In <br /> Fila With DWR `-t��� i (s«tions 7079,7010,7081,70e2,'W.[ur Code) ND 44244 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> DEPARTMENT OF WATER RESOURCES State'Well No <br /> . O .!rr Well Na 4 <br /> (1) OWNER: (11) WELL LOG: + <br /> Name <br /> Address Total depth o it Depth of completed well Q it <br /> -e Fatmatsaa Describe by rotor,r(serscter,slu of snstend,#aid shamfurr <br /> ` 3.3 6 ft to � ft <br /> (2) L A'I'ION OF WELL, ryo <br /> Count Y Owners mmmber of any 4 <br /> Township Ranee a Sect n Q y <br /> Distance from cities roads railroads etc y0 <br /> 4 <br /> (3) TYPE OF WORK (check): 7ZI <br /> New Well gL Deepening Reconditioning ❑ Destroying [] tie <br /> if destruction,describe material and procedure im Item I 1 S <br /> (4) PROPOSED USE (check)• (S) EQUIPMENT. j20 3 <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ 132 'S <br /> Irngation Test Well ❑ Other ❑ Cable ® r S <br /> Other ❑ SL 17Z <br /> (6) CASING INSTALLED: <br /> STEEL OTHER If gravel packed <br /> SINGLE ❑ DOUBLE 0 <br /> Gage Diameter <br /> From To or of From To <br /> ft ft Diam Wall Bore ft. ft <br /> � e o <br /> Size of shoe or well ring ' ty�� �'I Size of ravel <br /> Dese'lhe Joint a If <br /> sx <br /> (7) PERFORATIONS OR SCREEN. <br /> Type of perforation or name of screen <br /> Perf Rows <br /> From To per per Size <br /> it it row ft in xin <br /> t y <br /> (8) CONSTRUCTION O _ <br /> Was a surface ianuary sal provided? Yes ❑ No To whir depth ft <br /> Were any strata sealed agasnar pollution? Yes J3. No❑ If yes note depth of strata <br /> From ft to ft <br /> From ft to ft Work started 19 completed ]4 <br /> Method of-sealift WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS This well was drilled under my)urssdsction and thus report is true to the best <br /> Depth at which water was first found if known it of my knowledge and belrrf <br /> Standinq lead before perforattne if known ft NAME tZy t r� CL+. <br /> Standen [evel after (Person firm or corporation) (7 ped or prsatrd) PF <br /> R perfarsung and devele eng ft <br /> (10) WELL TESTS: Address <br /> Pump test made? Yeat ),Q <br /> ❑ No ❑ If yes by whom? <br /> d gal/min with ft drawdown after bet <br /> [SIGNED] <br /> Temperature of water (We[(Driller) <br /> Was a ehemmal analyses made? Yes ❑ No d <br /> Was elecmc Ioq made of well? Yes ❑ No ❑ If yes attach copy License No Date,] <br /> SKETCH LOCATION OF: WELL ON REVERSE SIDE <br /> DWR 1438 1REV 9 6S) 9639]93o io 6o ooM TRIP(DA OSA <br />