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' ORIGINAL WATER WELL DRILLERS RT rt _ Do Not Fill In <br /> n File with DWR 46 (Sections 7079,Toe o,7081,7032,Water cod.) <br /> THE RESOURCES AGENCY OF CALIFORNIA NO• 44386 <br /> DEPARTMENT OF WATER RESOURCES State Well No <br /> Other'Well No <br /> (1) OWNER- (11) WELL LOG: <br /> Name Mary Hart _ <br /> Total depth 152 ft Depth of completed well 1 ft <br /> Address L Munford Road Formanon Drirrabr by rotor r1wrarter,size of eastrrml and strwisre <br /> Ofit. 6 I ft <br />' (2) LOCATION OF WELL- 6 40 CIA,T <br /> County Owner t number if any40 4se) t� <br /> Township Range and Sectio. 2G �- ❑❑ 11 80 127 �y n <br />' Distance from curet roads railroads etc IL rl (�'�,� `� 127 146 rla�, <br /> (3) TYPE OF WORK (cher ). <br /> New Well'�1 Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> if destruction,describe materiel and procedure in Item 11 <br /> (4) PROPOSED USE (check) (f) EQUIPMENT: <br /> Domestic E] Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irngation ❑ Test Well ❑ Other ❑ Cable <br /> Other ❑ <br /> (6) CASING INSTALLED: <br />' STEEL OTHER I£ gravel packed <br /> SINGL50 DOUBLE ❑ <br /> Gage Diameter <br />' From To or of From To <br /> it ft Dian, Wall Bore fL £t <br /> size of of shoe or wellnn ff <br /> ! g � 6 1(, � Sere of gravel <br /> Describe joint t-V <br />' (7) PERFORATIONS OR SCREEN. <br /> Type of perforation or name of screen <br /> Perf Rows <br /> From To per per Size ti t F r- T-]i <br />' it it row it in x in <br /> 1 <br /> (8) CONSTRUCTION <br /> Was a surface sanitary teal provided? Yes ❑ N*3jD To what depth ft <br /> Weer any strata sealed aguisit pollution? Yes❑ No Q If yes note depth of strait <br /> From ft to ft <br />' From ft to ft Work atarted —C 1967 Compleud <br /> 196r7 <br /> Method of seals. WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS This well was drilled urtder my jurisdiction and this report is true to the best <br /> It?4 <br /> f <br /> Depth at which water was first found if kof my knoaedgeand belief nawa (s -_ <br /> Standing level before perforating if known ft NAME A.t�_ U,� Keq it J �~ 'tee L1 <br /> Standing level after perforating and develo io ft <br /> (Person firm or corporation) {Typed or rtnerd) <br /> (10) WELL TESTS: Address 'pox 400 <br />' pump"at made? Yes ❑ No If yes by whom? T.r%r9 i <br /> 9 gal/mm with ft drawdown after bra LS1GN6p] <br /> 11 DrNer) <br /> emperature of water Was a chemical analyns made? Yes ❑ No / <br /> Was electric log made of well? Yes 0 No ❑ If yet attach copy License No 1 1 44CZ ate <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> OWR 188 (REV g 63j 7 / 6629[95o so 65 som-rRIP Q 4 09P <br />