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' ORIGINAL WATER WELL DRILLERS REAWRT Do Not F'sU In <br /> File with DWR r 1 (sections 7079,7090,7621,70ez,Water cnde)WNO 44967 <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> DEPARTMENT OF WATER RESOURCES State Well No <br /> Ocher Well NoDl&fQ]Ef <br /> (1) OWNER- (11) WELL LOG: -�' <br /> Name J Total depth 'L4— ft Depth of completed vel[ ft <br /> Address Formation Describe by color char irter size of asaterset,sad sirattare <br /> ft to 4 :a ft <br />' (2) LOCATION OF WELL: <br /> yG-1 t1�.�_ 1-. <br /> County Owner s number ,(sey <br /> Township Ran a and section 1�-+'! �:!".9 42 <br />' Dlatanee from cities roads railroads etc Y l" L__7:73 <br /> II <br /> !F <br /> (3) TYPE OF WORK (check): 1,12 ? <br /> New Well © Deepening ❑ Reconditioning ❑ Descroyzng ❑ 102 1..- I:-- <br /> It <br /> --I destruction,describe material and procedure to Item I I 1 1 ! Lo l <br /> (4) PROPOSED USE (check). (S) EQUIPMENT. 11� 1, <br /> Domestic ® Industrial p Municipal ❑ Rotary 1�9 Ih <br /> ' Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ ] ` J 1 <br /> Other ❑ <br /> (6) CASING INSTALLED.- <br /> STEEL <br /> NSTALLED:STEEL OTHER If gravel packed <br /> SINGLE ® DOUBLE ❑ <br /> Gage Diameter <br /> ' From To^ or of From To <br /> ft ft Diam Wall Bore ft. ft <br /> i <br /> E�`ter <br /> size of shoe or well ring -k J Size of Rravel <br /> Describe)omt 01 a%a <br /> (7) PERFORATIONS OR SCREEN: <br /> ' Type of ptrforanon or name of screen 1one <br /> Perf Rows <br /> From TO per per Size <br /> ft ft row it in x in <br /> ' (8) CONSTRUCTION: <br /> Was a surface sanitary sial provided? Yes ❑ No a To what depth it. <br /> Were any strata staled agamat pollution? Yes❑ No❑ If yes note depth of strata <br /> From ft to fe <br /> ' From ft to ft Work started.!0:a1 271g completed <br /> Method of seals. WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS This well was drilled under my Inrtsdretton and Ibis report is true to the best <br /> of my knowledge and belief <br /> Depth at which rater was first found if known ft' T Standing level hefore perforating 1f known ft NAME tI a L. i+ �1' a or ice <br /> Standing level after perforating and developing ft (person firm or eotporation) (Typed or printed) <br /> (1 a) WELL TESTS: <br /> Address 752i zIcrea .. ,ea, <br /> lump test madet Yes In No ❑ If yrs by whom? ��-1 '_+Z 1 I;.I' , <br /> 11i Rel lmsn with �- ft drawdown after e. hra [SIGNED] t <br /> s (Well Dn)fer) <br /> emperuure of water War a chemtca)enalgs,s made? Yes ❑ No <br /> _ <br /> Was eleczrrc log made of well? Yes C3No ❑ If yes attach copy License No ated 19 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> ' <br /> t)WR 186 (REV gas) 5 ' 16391 96o 10 as ansa TgIP©A OSP <br />