Laserfiche WebLink
STATE OF CALIFORNIA Do Not Fil In <br /> THE RESOURCES AGENCY <br /> 0111GINAL DEPARTMENT OF WATER RESOIOCES N? 57002 <br /> Fits with DWR WATER WELL DRILLERS REPORT State Well No <br /> Ocher Well Nj N E— <br /> (1) OWNER (11) WELL LOG <br />' Name Total depth r�' f[ Depth of completed%eil res f[ <br /> Address ? l f 1 r l Forseacsen Artrrrbe by rotor rhararirr jjz,of via rr rral axd strsicl ure <br /> ft to ft <br /> (2) LOCATION OF WELL <br /> County Tri^' 4 Owner s number if anv ^ I <br /> Township Range and Section - <br />' Distance from cities roads railroads etc <br /> (3) TYPE OF WORK (check)New Well a Deepening ❑ Reconditioning ❑ Destroying ❑ � —If destruction,describe material and procedure in Item I I <br /> (4) PROPOSED USE (check) (5) EQUIPMENT 1 1 <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ <br />' Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED <br />' STEEL OTHER If gravel packed <br /> SINGLE Q DOUBLE ❑ <br /> Gage Diameter <br /> From [- or of From To <br /> - ft It Diam Wall Bore ft ft <br /> Phu.tit shoe or well rsnR Y4`Y I ^t' �Sve o'f entei <br /> lle ,,be wins <br /> rtzY <br />' (7) PERFORATIONS OR SCREEN: <br /> Type of prrtora titin or name of screen <br /> Yerf Rows <br /> From To per per Size <br />' ft ft row ft in x to <br /> (8) CONSTRUCTION <br /> 1 <br /> Was a urface <br /> sunitary seal provided) Yes No To what depth ft <br /> (� ❑ <br /> Were anv serasa -Ied against pollut—o Yrs ❑ No 0 if+es note depth of strata <br /> Brom ft to it <br /> hrom ^ �`^' r7^ <br /> ft to ft Work started 19 r � Completed l9 <br /> Method of.eAl,.R 1 - .. WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS Of My knowledge and belief <br /> This well was drilled under my jurisdiction and this report is true to the brit <br /> Deptls at which water was It,, found sf known ^ Ft <br /> standing level before perforating if known ft NAME <br /> r n <br /> (Person firm or corporation) (T)ped or printed) <br /> Standing level after perforating and developing ft <br /> (10) WELL TESTS: Address <br /> Was pump[es[made) Yes ❑ No ❑ if yrs by whom? i— <br /> ield gal/min with ft drawdown after hrs )SIGNED] t <br /> ) <br /> A em pen[ure of wirer Was a chemical analy ns made) Yrs ❑ No Q fW,11 Driller <br /> Was electric]og made pf yell} Yes T # '—_ r r-'- Dated O r I9� <br />' ❑ ho [] If ves attach ca pv License 1�0 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE 1 A <br /> DWR 168 (REV 9 6131 ,//t 12 1 29l79 950 9 58 9orA TRIP r„,n OSP <br />