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ORIGINAL STAIrz OF CALIFORNIA Do not ffli m <br /> THE RESOURCES AGENCY053739 <br /> Iie wifif�DWt� DEPARTMENT OF WATER RESOURCES No <br /> ,n Inreut NoWATER WELL DMLLERS REPORT state Well 14 r! + <br /> '�•._.s Fnrml4 No or Dar, r7—[9^6rr�-7 - Other Well Ndibtfi� 1 raj-3— <br /> (1) OWNER. hpr,r Nelson Ready Mix & Concrete (I2) WELL LOG. Total dept2ZO tt Depth otcompleted Wetl?Oft <br /> Athlresit P.O. Bob 545 from ft, to ft Pbrmatwn (Describe by color, character, sire or material) <br /> Ctty -Ii-)o-n-n7 C a. %lp_0 -- 2 Tm s a <br /> (2) LOCATION OF WELL (See tnshmetlons) a <br /> Caimty n Owriaes Well Numb 20 <br /> — 2 B Cls <br /> Well address A different from above 2 11 Bl and <br /> Townshi xagn Sae 1 2 Blue hla <br /> Dmlextcefrom sides,roads railroads,fer)e.s,a 20 52 Navy Dr. 2 — ue Sa <br /> lid <br /> Rtncktoa - 12 clay <br /> r se Ran <br /> - sae clay <br /> (3) TYPE OF WORI{i 1 a nd <br /> Now Nell x Doeppnmg 0 clay <br /> Reconstruction ❑ — <br /> Iteeondidoning ❑ - <br /> Horisamal Well p ' eVV <br /> — <br /> Desbuetinn 13 (Darcrlbe 2 — 02 lue C <br /> destruction matersats <br /> procedures in Icaa 02 - Sand <br /> (4) PROMISED 1}I - \I, R1 BinAdl& <br /> Dnmeatro 21 -- samd <br /> Ir101 r2 <br /> dus <br /> tfan ?Q <br /> ladlwtrGtl [� <br /> T Well 0 <br /> w �jr S• - <br /> Maniclp � <br /> WILL LOCATION SKETCH other CJ <br /> (5) RQUIPMENI'. (E) GI9A,V AC$• 0 0 <br /> Rotary ❑ Reverse xk�k, <br /> *7o Si: <br /> Cable ❑ Air ❑ <br /> r of be <br /> Other ❑ Bucket ❑ E\fo59 <br /> 2 - <br /> (7) CASING INSTALLEZ\\'. <br /> (Il) SRFORA <br /> p1140r <br /> Stao1'�' Plastic C) type a(p or nE s — <br /> Fronn Tf in I)lR Ga cn To - --' <br /> ft. WaH ft, ft Z - <br /> 0 2 1 - <br /> (9) WELL SEAL - <br /> Waa surface sanitary sisal provided? Yew.N No ❑ If yes to depth__. Q^ft <br /> Stere s4rita 90401 aeadn t pollution? Yes❑ No 0 Tnter/W It — <br /> Method of maLn Work StartCompht�t 18 <br /> 00 'WATER LEVELS WELL DRILLERS STATEMENT_ <br /> Depth of flat water, if known ^, This mail was drilled sutler mg lr+radretlon err !s report fs Ince to the Last of mu <br /> Standing level after well camplsti knowledge and befi <br /> (11) WELL TE5T5r SIC*rrrr _ <br /> Was well test made? Yea No ❑ IF yea, by whams H_ el �n S ��,,,,,� ,�ILI (Well Driller) 0/ <br /> Type of test Pump Bailer❑ Air lift© NAM S Bro g. Drilling_ C o- jl a a <br /> l]epih to water at start of test..—ft At and of test ft Person,firm,or oorporaLon) (Typed or printed) <br /> �' ����''G -81+0 ollmin after,�hou s Water tampern Address 159;4 Pelandale Aye* --_ - <br /> Ga�'R analyait made? Yes ❑ No if Yet by �rhom? CityMod <br /> iYs�ele Z lag made? Yea ❑ 110 If yas,attach cary to this rips( License No, ate of this report— 9-6-79 <br /> qW <br /> oWR 1118 4RaV 7 7e) IF ADDITIONAL SPACE IS NEEOED, USEi NEXT CONSECUTIVELY NUMBERED FORM <br />