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w <br /> i <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMI=IVT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 277766 <br />' C Stice of Intent No State Well No. <br /> Local Permit No or Date ~ 8$ Other Well No O <br /> (1) OWNER Name G 7 <br /> (12) WELL LOG Total depth � - ft Completed depth 3$ft <br /> Address from ft to ft. Formation(Describe by color character size or material) <br /> City �AJ{IQ1ll i" ZIP <br /> (2) LOCATION OF WELL (See instructions) 4� _ <br /> County r„SAuaJ&l Owners Well Number AL. <br /> - <br /> Well address if dtif`e�nt from above N4132'4-119- <br /> Township 7�N Range �� Section L <br /> Distance from cities roads, railroads,fences,etc. _ <br />' 1 (3) TYPE OF WORK <br /> New Well x Deepening ❑ j V <br /> Reconstruction ❑ <br /> - • _ <br /> Reconditioning © n <br />' Horizontal Well ❑ �� ���� <br /> Destruction ❑ (Describe <br /> I destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> IndtuAell ❑ _`,A/j <br /> Test <br /> h.U <br /> � Test el © <br /> n <br /> i htumcipal ❑ \��� /� ^ <br /> I Other <br /> 71, <br /> WELL LOCATION SKETCH be) <br /> (5) EQUIPMENT <br /> VEL ACK <br /> Rotary ❑ Reverse ElNo'1� <br />' Cable ❑ Air ❑ <br /> Other x Bucke ac ked from <br /> ffGl/Civ $r�$x V - <br /> (7) CASING INSTALL£I} 1 (8) PERVORATIONS. r _ <br />' Steel ❑ Plastic n Type`fperforationorareof <br /> From T 'int Gage or f\k�irtl Tor< <br /> ft #t� i� Wall `fk tt'� ,\ /size <br />' O 3 Yo Z 3 <br /> (9) WELL SEAL = <br /> Was surface sanitary sea[provided? YesK Nolf yes,to depth Z r ft <br /> Were strata sealed agar t polkution? o Inte�Val It <br /> Method of sealing Work started 19 Completed --27- 19 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known zZ 5 It <br /> Z LO. 8 This s fled under n ict:on and this report is True to the <br /> Standing level after well completion ft. bes'of ria lC o rid <br /> (11) WELT. TESTS Signed <br /> Was well test made? Yes ❑ No If yes,by whom? J ! <br /> 'e of test Pump ❑ Haller ❑ Au lift ❑ NANrtE 4L.t ry <br /> f <br /> It to water at start of test It At end of test ft. (Pg¢on u o =atton}(T o t } <br /> charge gal/mm after hours 1kate perature Address �] <br />' Chemical analysts made? Yes No ❑ If ies by w In f v _ ZIP <br /> electric elecc log made Yes C3 No If y act faIV&n. License Na PE Date of this report `3-ZZ <br /> 4WR lea (REV 12861 IF ADDITIONAL SPACE IS NEEDED USE NExT CONSECVTIVELY NUMBERED FORM 56 96355 <br />