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I P Op± � <br /> RIGINAL STATE of CAUFORMA DO not f12I SA <br /> Pile with DWR THE'RESOURCES AGENCY <br /> b DEPARTMENT OF WATER R21cSOURCES NQ.3 61 Lry <br /> 3 <br /> WATER WELL DRILLERS REPORT <br /> \o[ictt of intent Ao. Stare LYell Ko. <br /> L"cal Permit leo.Or Date Other E <br /> L OWNER. Mame (12) WELL LOG:.- Tota do p tl�5ft <br /> pth2,15._it Drptft or rnm !fled n'e <br /> Addrrsa 451 N. li�I ian fm,,, ft. .to It. Formntinri (Describe byrnlor, character, size ai materia!) <br /> G,tp Zip <br /> (2) L CATION OF. WELL (Sep instnlvtivrav): - <br /> Ci„mtv an JOa Lllri Owner'r,Nell Number65 73 - sand <br /> {Vr1l odd rens it ditrerent Frum abnVC <br /> 73 - 90 clay <br /> F' Tu,t�,chiP_ n��_ nH[ Section 90 101 cemented gravel k <br /> i <br /> Distnncr.lettm cities, roads, ndln,n&. Iences,etc 3101 105 clay <br /> 105 - 108 sand ' <br /> 108 125 clay <br /> .125 _ 130 grave <br /> (3) 'TYPE OF 1VORK: 130 4 O G ay . <br /> New Wa0b Dee"hisic ❑ 14 45 rave & san <br /> f. Rrn,nxt;tiCuo,l ❑ . <br /> i - RC(z7aditinninA ❑ 1.58 162sanct <br /> horizontal WL u C) C ay . <br /> c D"truirionj Flaturibe san <br /> �- - destr ction ronterinls told - <br />' prrxedures in Im-n 1E) G <br /> (3) PROPOSED USE: . l Q _ 194 ' clay <br /> pnme.StF�' <br /> M1 194 205 ±sant <br /> IrTitatinn a °205 215 clay <br /> lnauxtri,il ❑� . <br /> Test {vel! 0 <br /> # Stock - ❑ _ - <br /> �'- .. Municipal (3 <br /> WELL LOCATION SKETCH Other O - <br /> �.(5.) EQUIPMENT! l6) GRAVEL PACK!. _ <br /> Hn;ary - Arvrrxr C) Yes ❑ No ❑ Si.. _ - - <br /> Cahle ❑ Are ❑ Of mctcr of bore <br /> Other a IIuekot ❑ packed fmmtO Ft. _ <br /> (7) CASING INSTALLED, (ti) FEAFORATIONS: - <br /> Steel 0 Plnstle ❑ Cnnrttrte 0 T)-pe of ptrfnratipn nr vire of screen _- <br /> Froul To Dia. Gage or From To. Slot <br /> ft, ft. in. <br /> IWA ft. ft. size - <br /> (8) WELL SEAL: <br /> ' Wei surface 2anitary -cal provided? yenp Nr q It y'cs, In deptls___aj0 `ft. - <br /> Wore strata sealed alrainst ynllLtion? Yrs ❑ No ❑ inters„t T fL -.. <br /> Method of rcoliss Work -tartGdL, i9 Complet 1B <br /> Ili (10) WATER LEVELS: WELL DRILLER'S STATEMENT. <br /> I)e9t11 „i first ,eater, if kau,+- This Willi iVaJ tdrillcd under my ;ueftcticriun and fhlx'repuif is rnrr tn-the best of-skll <br /> Standinr level after well cumpktinn — - _ eft, kriowledrie and bsAef.- <br /> (11) WELd, TESTS: SIGNED <br /> Was well test niade? Yes G No G If yet, by whnm?- — t{Ve Unililer) <br /> Typo of test pump p Bailer❑ Air If[t C3 ]NAME <br /> Depth .to -eater it st:,rt ,f testft. Ar tact ,f test--ft wal b Ren, to T p <br /> DisChRtC[ L'al/min after hnetrs {V1iter.tempemrwe Address <br /> whnm?Lf+) <br /> rnodr? <br /> Cit, .StT.km �v. <br /> Chtmical nnnlv919 1'<s E] Vv irJ rs, h-• , 200794 <br /> {{' •,esie 1nR medr? Yr-.C) No Ll if 5'cs. :ittnch cops to this revert License Nn. .,.....,Date of this repo <br /> oB ,qev.y-yei IF At7UITIONAI-5PACE`1S NEEDEp, USE NEXT CONSECU TIVELY NUMBERED FORM 'leiv9607-792oµ <br />