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SrA'=OP CALle0aNIA <br /> ORIGINAL Tme ReSOUr-iCLS AQENCY Do not fill in <br /> File with [)WR DI~PARTMENT OF WATER RISSOURCES <br /> q WATER WELL DRl!:LLERS REPORT No. 253284 <br /> to Ice of(meal Na z S r State Well Na <br /> -al Permit Na or Date Other Well Na <br /> (1) OVVN$A Name )'leers tea ?WS TxtG (12) WELL LOG Total depth__1(_9 ft.Completed depth 2 32 It <br /> Address from ft to ft Formation(Dewnbe by calor,character we or materinl) <br /> G ZIP 0 <br /> (2) LOCATION JQF WELL(See instruetfons� Lin _ 13 ©) J i I +- <br /> Court Owners Well Number !'` — ren- 1 1 G I G <br /> Well address[(rhfferent From above <br /> — r 1 I h` <br /> Tmvnshlp Range DLE Section 19 _ Z8 <br /> fs� <br /> Distance from cities._fproam,railroads,fe ces,eta Z -" <br /> ro asp ' J��, a rl - <br /> N (3) TYkPE OF+WORK <br /> A ^ <br /> t New Well �J Deeperung ❑ <br /> Reconstruction D <br /> Recondtkantng ❑ <br /> Horizontal Well ❑ <br /> Destruction 0 (Describe <br /> destruction materials And pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US _ <br /> Domestic <br /> Irrigation <br /> Industrial ❑ _ <br /> A tai r1 'Fest well � ❑ <br /> �l Irfunici 1 vvv ❑ T Q <br /> tt �d O or <br /> WELL LOCATION $ RTCII lbs) — <br /> (5) VQUIPMENT GRA CK, <br /> Rotary ❑ Reverse ❑ 1Vo 1z <br /> Cable ❑ Air ❑ 1� bore <br /> Other jRr B \ d rem 2 <br /> (7) CASING INSTALLED (SJ PEB @ 'T <br /> Steel 11 pbshe or t Ty of orstseaf Q <br /> From T t Cage or t <br /> ft. f I Wall t size <br /> � e•0zb <br /> (9) WELL SEAL, <br /> wassurfacesanitsrysedprovided? Yes W' No❑ ifyes,tadepth IL <br /> WeramwasealedagalostpoU,a1km? Yea ❑ Nowa interval iL <br /> Methndafseaifag m f 1 Work started 5 Com &ted I L`1� 1921 <br /> (10) WATER LEVELS. WELL DRILLEWS STATEMENT. <br /> Depthof ftralwater,,fknown - -�Z^-- ----- - This well wm drO&d ander mV Jurisdiction and this report is true to the <br /> Stoading level after welleompletian r t�- -J-� fL best of rag knowledge and ba[ <br /> (11) WELL TESTS Signed <br /> AChmwalamalysismade? <br /> well test made? Yea ❑ No f� If yes,by whom? (W railer <br /> of te+t Lump ❑ BaBtx 11 Air Itft ❑ NAMF <br /> htotirateratstart ofW It. At end of test IL (Re n.F; corpora )(Typedorprint ) <br /> arge gal/miaafter—hours watertcmpesature Address <br /> Yes© Ne� If yea by whom? City Lz a ZIP <br /> Was ekawe log made Yes❑ No li m attsch to thb n t LleenseNa Date of this report <br /> PWA 186 MKV 18-861 1F AUDMONAL SPACE 1S NEEDED, USE NEXT CON"JSCUTIV@LY NUMBERED FORM eb 9dtlS5 i <br />