Laserfiche WebLink
STATE OF CALIFORP41A <br /> REGINAL THE RESOURCES AGENCY DO not fill <br /> ' File With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0, 259666 <br /> • l J ice of Intent No. State Well Na <br /> LOLaI Permit No. or Dale Other Well No.42 - <br /> (1) OWNER: Name (12)(I2) WELL LOG: Total depth�2ft. Completed depth-/JCL <br /> Address from ft to ft. Formation{Describe by color, character, size or mater !i <br /> City 0 ZIP _ <br /> (2) LOCATION WELL (See instructions): <br /> County_� 4k _Owner's Well Number — <br /> Well address if different from above iN, — <br /> Township z S flange^ F-kE Section — IV <br /> Distance from cities, roads, railroads, fences,etc — <br /> 1 Sm•4 <br /> 7 - <br /> 69. AAM <br /> (S) TYPE O�FRK: <br /> r New Well Ed' Deepening ❑ <br /> r Reconstruction ❑ — <br /> lr II <br /> Reconditioning ❑ � <br /> Horizontal Well ❑ �. <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> lir (4) PROPOSED US _ 7 wl I <br /> Domestic <br /> �-xIu f Irrigation J <br /> Y Industrial Ll — t-N<,` j• <br /> ' Test Well ❑ <br /> i O <br /> Munici l ❑ _ ^C <br /> WELL LOCATION SKETCH be) <br /> (5) EQUIPMENT. GRAY CK: <br /> Rotary Reverse ElNo �\ <br /> C2bie ❑ Air ❑ ete f bore 1 <br /> �1 <br /> Other ❑ Bucke rom -' <br /> � n — <br /> (7) CASING INSTALLED (8) PER TI <br /> steel ❑ Plastic ❑ Ty of on or size of Q — <br /> From Tkr'KDia. Gage or < t <br /> ' ft. f i Wall t size <br /> •V - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If yes,todepth ft <br /> Were strata sealed against pollution? Y No ❑ Interval ft <br /> ' Method of sealing Work started-- i Completed <br /> (10) WATER LEVELS: WELL D4- e <br /> ' STATELNT:Depth of first water,if known ft Standing level after well completion ftThis well wer m jd this report is true to tj <br /> best of my kbel <br /> (11) WELL TESTS: <br /> Was well test made? Yes ❑ No ❑ If yes,by whom? Signed <br /> a of test Pump ❑ Bailer ❑ Au lift ❑ NAME (Well Driller) <br /> ' t ,rh to water at start of test f t. At end of test ft <br /> {Pevso firm,o rat' T r print } <br /> Discharge gal/min after hours Water temperature Address Q <br /> Chemical analysis made? Yes ❑ No ❑ If yes,by whom? City ZIP _ <br /> ' was electric log made Yes ❑ No ❑ If yes attach copy to this report License No, Date of this report t <br /> DvyR 188 IRtry• 124M 1F At)OMONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> M <br /> %i• <br />