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ORIGINI. STATE OF,CALWORNIA Do not f l m <br /> THE RESOURCES AGENCY •� <br /> VithDWR DEPARTMENT OV WATER RESOURCES No. 19 l6 8A <br /> WATERWF L DRILLERS REPORT State Weil Nt Na ar nate Orl+er weu tan.t�11uG16�c�� �r 1'� <br /> (1) OWNER. Na., (12) WELL LOG row dnptlr� �f i�s` °w - _fit <br /> Addrar 0 from It to ft. Fosmahea (Doscribe by color cbasncte, shv-1 or material) <br /> (2) L CATI N OF LL (see fustrsrctfnns) _ <br /> County Owner's Wen Number <br /> LUWAID -AN-4 <br /> Well n4dren ii different hem above <br /> Dtmance from cities,roads,railroads fe=w.etc � �L en <br /> r <br /> a rl'V <br /> (3) TYPE Or wozuc <br /> New WellDcepemmg p ..'L <br /> Rernnstnectfoo El Jw 26 100-70� <br /> `� Rxonditlmhlseg 0 {+ — ,Z'r 'fl(`� <br /> Horizontal Well 0 <br /> Deattucefan (3 (IJaserdva 1•;�.. '^ r <br /> M �� �p destruction materinla <br /> I'f iA ewe'lope— pm=durn in Iters fd <br /> 1 (4) PR MOSIE:D • <br /> I } Ilomest.a .rJ <br /> Irftmtfouel�\ o <br /> wall '`�� 0 <br /> /� lifRofci � <br /> VV=LOCA'T'ION S=TCH �.� other 1W wirC *Sol' <br /> (S) EQUIPMENT (a) GRAN PACS, �:� ff •� �� <br /> ftolaty ❑ Boverse ❑ a <br /> Cnble 0 Air 011%. <br /> Other X tAT4GaRr B,.k t 6 ILJ — <br /> (7) CASING INbPA1.I.SD S'~�L� (8) ORAHOVkL . <br /> Steel 4d Plastic[} `+ Type of ortiarze of `;? <br /> Ftorn To,— Dfa Gage rfr R13To slr <br /> � t <br /> W <br /> — (h rh1 <br /> v�:ti y <br /> (B) WELL SEALi <br /> Was UR bce Tanury seal pmvfdod? Yes x No 4 If Yes,to deo - aU3 S, f � <br /> W.& ,tram seated t polkudon? Yes❑ leo 17 Intm+al - r <br /> Method of sea Work r I9 <br /> (10) WAM LEVEISI REI L DMLLER'S STATEMENT <br /> Depth of first water. If know This wen"Um drilled ander mvr4!v0dkHm nd Mis r8port fa Ines to the best of 7ny <br /> Stanwng level after Wen Completion *000 <br /> (11) WELL TESn. S; <br /> tiVas woks test made? Yest No Q If Yak, by wheml(WAA1164 (wen nei) <br /> Type of teat Pump E3 aft❑ NAME �4 <br /> Depth to water at start of test_ _—_.ft Af and Of test - Et (P Srm,or corporation• or printed) <br /> + ryeypl/min after �Rn �Ya6er tempqer�a <br /> Aa <br /> .w I- made? Xa'A bio ❑ U Yea, by Wham?CNLL.., atY <br /> a ekscbio log made? Yes 0 KBA If yes attach covy to this revolt Ltcanae No a oI shin milt <br /> WR 050 (sett+/ 7-707 IF AD131TIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED ]FORM <br />