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ORIGINAL STATE OF CALIFORNIA Do not fU in <br /> File with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 097909 <br /> of Intent �,�-�_ WATER WELL DRILLERS REPORT <br /> Q/� State Well No <br /> -nit No or Date61`__,� <br /> Other Well No i <br /> (1) OWNER ,,,1ie r� C ' <br /> (I2) WELL LOG Total deptl fr Depth of completed well 1, 25 <br /> Address from ft to ft Formation (Describe by color character size or material) <br /> City `jnaa,--�I if yip 95365 - and <br /> (2) LOCATION' OF WELL (See itlstructlons) rd an <br /> County Owner's Well Number - ay <br /> Well address if different fin abu%. an <br /> 18 Township Rrn�e 7 ecU - 44 aY <br /> DutamcL fnnn uteri r„aJb railmoda lens",etc 23418 S• WjLma - <br /> 47 - <br /> l�G (3) TYPE OF WORK azits <br /> New Welly] Deepening ❑ E _ <br /> Reconstruction <br /> ^y Reconditioning F-1 <br /> Horizontal Well ❑ <br /> 1� Destruction ❑ (Describe <br /> destruction materials a <br /> ` ! r procedures in Item 1 A C-10ye ^4 stalled <br /> #A4" Ad <br /> • i (4) PROPOSED <br /> gpgnaible <br /> b <br /> N4[lk�- Domestic moving Of the <br /> Irngation�� <br /> Industrial ❑ <br /> tt.S <br /> T Well Cl <br /> Sr <br /> r /Y/Yf�+t�G.J Munici <br /> WELL LOCATION SKETCH Other ❑ _ <br />(5) EQUIPNILNT (6) GRA PACE <br /> Rotary Reverse © $1 No Size <br /> C ihle ❑ Air1i <br /> ❑ r of bore <br /> Other ❑ Bucket ❑ NV _ <br />(7) CASING INSTALLED (S) ERFO A C _ <br /> Sleet Plastic g1 C c t Type of pe nor a of scree - <br /> From ToDIa CQfJr Fwg To - <br /> ft ft In Wall ft s z <br />(9) WELL SEAL - <br /> Was surface sanitary seal provided? Yes [k No C] If yes to depth iQ ft _ <br /> Were strata sealed against pollution? Yes ❑ No [k Interval__ - ft, _ <br /> Method of sealingcement work stn 1120—19-8j0- (-m ilr lfl <br />(10) WATER LEVELS WELL DRILLER'S STAT ME ' <br /> Depth of Irst water if know ft This niell win under tide MR d r wp-ov u trsar to the first o► my <br /> Standing level after well compleho knowledge S <br />(11) WELL TESTS SIGNED <br /> Was %ell test madea Yes ❑ No [X If yes by whom" (Ke D. r <br /> Type of teat Pump ❑ Bailer ❑ Air lift o NAME Panero W <br /> Depth to N Mr at start of test ft At end of test--ft 314g�r> ,rRriiLDri�" eT� dtwtrsll <br /> n Norge-_____„__atal�ittin after kours K'ater temperature Addreu �i� <br /> rnrl.,y nude• 1� ` .,, ❑ If ,� b, KhSMn � I.t�r>,e �,i 081[aa le, ���i��.,, _ ��p__ 95 351 <br /> ci - <br /> rn, <br /> DWR 188 wcv 7 745 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY N UMSERED FORM <br />