Laserfiche WebLink
ORIGINAL JOWATER WELL DRILLERSRT Do Not Fill In <br /> File with DWR n (s6er,en,7079,7020,7083,70112,Water Code) IV O 44960 <br /> Y L' THE RESOURCES AGENCY OF CALIFORNIA state a Well No <br /> DEPARTMENT OF WATER RESOURCES <br /> Other Well NdalAwElzrl <br /> t (1) OWNERJ` (11) WELL LOG: <br /> m <br /> Nae i <br /> Tocol depth 1 ft Depth of completed well ft <br /> Address • - • - - Formation Driersbe by color,rbaracter,tragi of metrr7ef,and slrrctare <br /> - ft to _ - - - ft <br /> WELL: , <br /> (2) LOCATION OFun .6 ; <br /> 3 <br /> Coty - - Oworr s number <br /> Township Range and Section -+• - - .. <br />' Durance from cines roads railroads etc 'r f - - - f <br /> r ^ i <br /> (3) TYPE OF WORK (check): - <br /> New Well to Deepenmg ❑ Reconditioning ❑ Destroying ❑ <br />' <br /> If destruction,describe material and procedure In Item 11 - _ <br /> (4) PROPOSED USE (check). (S) EQUIPMENT: i _ T <br /> Domestic ® Industrial ❑ Murucipal ❑ Rotary 0 i , ~� <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable [] i <br /> Other ❑ <br /> (6) CASING INSTALLED. <br />' STEEL OTHER I£gravel packed <br /> SINGLE b. DOUBLE ❑ <br /> Gage Diameter <br />' From To or- of From To <br /> ft ft Diam Wall Bore ft. ft <br /> J 1 - <br /> v <br /> Size of shoe or well rang Size of arsvd <br /> Describe bene 1 V 3u <br />' (7) PERFORATIONS OR SCREEN: YU' <br /> Type of perforation or name of screen <br /> Perf Rows <br />' From To per per Size <br /> ft it row ft m x m <br /> 1 <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes Ig No ElTo what depth - ft <br /> Were any strata sealed against pollution? Yes ❑ No❑ If yes note depth of strata <br /> From ft to ft <br /> From ft to ft Work starred••;- -y y-a9 completed - 1-19 <br /> Method of snitnR „v r�+u WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS: This well was drilled under my Jurisdiction and this report ss true to the best <br />' Depth at which watts was first found if known ft of my knowledge and belsef- - - <br /> Standm '-g level before perforating if known ft NAME + �� -- -+• <br /> (person firm or corporation) (Typed or prinird) <br /> Standinglevel after perforating and developing ft <br /> (10) WELL TESTS- - -- - Address - j- <br /> lump test made? Yes ] Ho z ' -L <br /> ❑ If yes by wbom? <br /> Mal/min with - - ft drawdown after - hr, [SIGNED] <br /> emperacure of water <br /> Vasa chemical analysis evade? Yes ❑ No (Well Driller) <br />' War electric log made of trek? Yes ❑ No [] if yes attach copy License No gated '' , 19-.— <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DW R 188 MEV g g5) 1 aJ, 116291 D50 10 6y 90M TRIP O A OSP3`k <br />