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y � I <br /> ONi iNAL - - - STATE OF CALIFORNIA r - Do not fiU sa <br /> !a THE RESOURCES AGENCY C <br /> V <br /> R DEPARTMENT OF WATER RESOURCES No. 185790 <br /> No WATER WELL DRILLERS REPORT State Won No <br /> or Dat other well No.ef 06Gr0=419- <br /> P) OWNER N MAL. (12) WELL LOG. Total deptl. #-Depth Of camyietea,loan—� <br /> Ad 1{/ f vin ft to it Fowmateon (Deserlhe by color, character, size or material) <br /> Clty — <br /> (2) LOCATION OF WELL (See instruchoag) _ <br /> CouutY—- �a Owne�a Well Nuw '+ <br /> Wen addim if dilEe ut from sbo <br /> Townshi �� " <br /> Dttaara a8ia,roads, fences — <br /> c <br /> (3) TYPE OF WORK I <br /> New Well Deepening❑ <br /> O Reconshvcum C) _ 4i <br /> ❑ Y �� <br /> nodzamtal Well ❑I `i,`, ��ti rti}} <br /> Destruction Cl (Dascrl6e �. — <br /> destruction materraL plod <br /> pmaeduras in Item 12) `� <br /> (4) PROPOSED'-qSF-P <br /> Domestm <br /> � r � <br /> Inderstrlal�� ti ❑ ` �-� r �` � �•.� <br /> Tait wen -� D - <br /> � t <br /> AVY rIW,, <br /> WELL LOCATION SEMTCK <br /> (S) IEQUIXIMERr (e) 619 PACIK% <br /> $otary 0 Reverse ❑ ` To�R: No--O <br /> Y <br /> cable 0 Air p 'afar Of <br /> Other ta&SM <br /> Bucket [a factk dm ti <br /> (7) CASING 3MTALLEDtt + {S PERFOgA1IQ <br /> S y� <br /> Steal❑ Plasde Cana(eta[] Type of pezfp`rn!>an or Jura of <br /> From To-;- DIS. Gage or F30f c 1 TO ° I <br /> 111. Wall {t.K�`o. ft .L sme -- <br /> '+, q. <br /> �•� <br /> (9) WELL SEAL. <br /> Was mnface sanitary seal provided? Yes. No ❑ If Ya. to&Ptb t — <br /> Were strata sealed agRinaL tlntian?f Yes No 13 — <br /> hiethod of ark 8 Cam <br /> (10) WATER LEVELS) WELL DRTLLER'S STATEMENT <br /> Depth of first water, if )no Yh[s well trndar mV lurbdiclfon and thio rvMrt m ims to the beat of mV <br /> Stamling level after well compietrerL., • t! k+n�oieefq o <br /> (11) WELL TESTS) S <br /> Was well test made? Yes d No if yes, by wham? . (W 1' <br /> Type of test Pump ❑ Bailer❑ Air Eft ❑ N <br /> Depth to Water at start of test w. At and Of takt 20 <br /> Z or prr pal <br /> sUmut Water tempera '+•-� � �� <br /> analysis made? Yes ❑ No ❑ If yes, by wham? ` <br /> tnc lag made? Yes❑ No [3 If yes,attach copy to this report Xlcaaae No '57 21Z=& Daft of thfs repo <br /> DWR 188 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />