Laserfiche WebLink
` STATE OF CALIFORNIA <br />' ORIGINAL � • Da not fell rn <br /> THE RESOURCES AGENCY <br /> Flie with DWR DEPARTMENT OF WATER RESOURCES No. 096881 <br /> Intent No WATER WELL DRILLERS REPORT State Well No <br /> rermit No or D1te Other Well \o [I`-- <br /> (1) OWNER %ame O T�� y� <br /> (12) WELL LOG Total depth/.y^ Oft Depth of completed well�0ft <br /> Address 0 U �J4 1w-Z- from ft to ft Formation (Describe by Color, chlr-kcter size or material) <br /> City Cip - r <br /> (2) LgCATIO�OF WELL (see Instructions) — O i <br /> CuuntN /97t-'� D Ct Ow ner s Well Number - �► L <br /> "'ell addre if diffe aboveL'riJ d � - �Z <br /> r t rL l �/tiv! 5' <br />' Township Raode <br /> Section_- w Lr <br /> Distance from cities roads railroads nes etc ! <br /> ?rc./ <br /> - L <br />' Q <br /> e (3) TYPE OF WORK -f <br /> New Vvell gf Deepening ❑ <br /> ea <br />' O TQ L (.C/t r r-3 Recorsstntchnn ❑ _ sa <br /> Reconditioning ❑ d _ <br /> l Horizontal Well ❑ FD _ e- <br /> 8 Destruction ❑ (Describe - <br /> T destruction materials and Uc <br /> M B procedures in Item 12) f <br /> „ S (4) PROPOSED USE <br /> nmesec <br /> t 5 rogation ❑ -1�6 _ <br /> Industrial ❑ -;V� <br /> Test Well ❑ <br /> `/.� e stock ❑ - � G <br /> 9 - /TttiF4 <br /> unicipal <br /> WELL LOCA ION SKETCH Other - ❑ _ <br />'(5) EQUIPMENT (B) GRAVEL PACK <br /> Rotary It Reverse ❑ Yes [� No ❑ Size �F <br /> Cable 0 Air ❑ Diameter of bore �~,�/� _ <br /> 1Other ❑ Bucket E] Packed from-5 to 02ft _ <br /> (7) CASING I%STALLED (8) PERFORATIONS c` <br /> SteelA Plastic ❑ Concrete ❑ Type of perforation or uze of screen From To Dia Gage or From TO slot - <br /> ft ft in Wall ft ft ,s.ze _ <br /> 9) WELL SEAL _ <br /> Was surface sanitary seal provided' les pg No ❑ If )es to depol�6 —ft _ <br /> VWere strata sealed aga t pollutron� `Yes ❑ No ❑ Interval ------ rr <br /> {cthod of seakn Work startI9 Complet 19 <br /> (10) WATER LEVELS q q WE L BILLER S S ATEMEi�Mi-,,- d, <br /> Depth of first water, if know [ Q ! This 11 w rilled under my isdir OrN is t p tq the best of my <br /> tanding level after well completio ft krioule a and elief <br /> 11) WELL TESTS <br /> NED <br /> IRVas well test m ide" Yes [3 \o If yes by whom? t (W rd er r� <br /> Type of test Pump ❑ Bader ❑ Air lift ❑ <br /> `TAME <br /> Fepth to «Ater at start of test ft At end of test fr (_Person firm or co 3y o <br /> -'1ATge gal/nnm after hours Water temperatureAddres + <br /> Weanalysis made" les C3 No X If N es by whom" City Q�b/ /- ,� "�!� 'Zip <br /> ctnc log m'ide" Yes ❑ No if Nes attach copy to this report License No �CO ��� Date of this repo <br /> ert,.,, G VW. <br /> lea (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 2 <br />