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i <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> File With PWR (Sectsom 7079,7090,7011,7032,Water Coda) NO 44921 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> DEPARTMENT OF WATER RESOURCES tate Well No <br /> Other Well No l <br /> ' (1) OWNER: (11) WELL LOG: <br /> Narne P Total depth _14700it Depth of completed welly 4' it <br /> t Address y^ .rQ Formation Derersbe by color,ebanrter,rose of mstersal,and itruelurr <br /> •rte To ITr:�r ft m ft <br /> (2) LQCATION OF WELL: <br /> County'VWQ Owners number if any <br /> ' Township Range and Scene. }� <br /> Dtstance from Ctnea roads railroads etc t'Ia r f <br /> AR, s RU azT`a & "' ' /0!1- 04 <br /> ' (3) E OF WORK (check): 41 <br /> NewWell Deepening ❑ Reconditioning EJ Destroying C] 1 C <br /> If dertrur tows,describe material and Procedure in Item I I 1 <br /> (4) PROPOSED USE (check)• (S) EQUIPMENT: — D =f <br /> ' Domestic Rr Industrial ❑ Municipal El Rotary ElIrrigation Test Well ❑ Other ❑ Cable <br /> Other <br /> (6) CASING INSTALLED <br /> If gravel packed <br /> STEEL OTHER <br /> packedSINGLE DOUBLE ❑ <br /> ' Gage Diameter <br /> From To or of From To <br /> ft ft Dinm Wall Bore ft. it <br /> Size of shot or well' ring <br /> p, X7 Size of gravel <br /> '.Describe point z/; 41V410 <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perforation or name of scree. <br /> ' Perf Rows <br /> From To per per Size <br /> ft it row it to x in <br /> 1 <br /> ' (S) CONSTRUCTION: 4 <br /> Was a surface sanitary sal provided? Yes No❑ To what depth a/ it <br /> t ®ere any strata sealed agatnir pollution? Yes❑ No❑ If yes note depth of strata <br /> From it to it <br /> From it to it Work started 19 Completed () C wwti <br /> Method of sash. WELL DRILLE114 STATEMENT <br /> ' (9} WATER LEVELS• This writ was drilled under my jurisdiction and this rePo^t is true to the best <br /> of my knowledge and belse <br /> Depth it which water was first found if known ft _ f <br /> Standing level before perforating if known it NAME �mi v` 4 td <br /> (Pera.a fir o eorporatton) yped or printed) <br /> ' Standtn levei afire rforatin and developing ft [.� � tJ <br /> (1 D) WELL TESTS: Address <br /> a pump test made?Yes ❑ No ❑ If yes by whom? <br /> 10ld sal/mist with ft drawdown after hrs [SIGNED] <br /> (We?DrrlJrr) <br /> Temperature of water was.chemina]aaalytn modes Yes ❑ Ne ❑ <br /> Wit electric log made of well? Yes ❑ No ❑ If yes attach copy License No <br /> C-3"7- <br /> ' SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> 76991 FISO 10 85 SOSN TRW(D 0 SSP <br /> z n BB IREV 9 ws) <br />