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r ' STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill In <br /> File With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 287009 <br />% e of Intent No State Well No <br /> 't,Permit No or Date �� i+,L,Ly �� I Other Well No <br /> (1) OWNER Name 0 (12) WELL LOG Total depth ZL?D ft Completed depth /46" ft <br /> Address 104SID i2C 0 Q <br /> from ft to ft Formation(Describe by color character size or maters?!) <br /> City , zip <br /> (2) LO('ATION OF WELL (See Instructions) — <br /> C outily t 1 Owner s Well Nyu*ber <br /> Wt II addressif different from abov — <br /> Township L) C/ Range�Section — t <br /> Distance front cities roads, r..I.d,, fences,etc — <br /> r� <br /> (3) TYPE OF WORK <br /> L 5 New Well K Deepening ❑ f — <br /> ' � Reconstruction ❑ <br /> Reconditioning ❑ = <br /> — <br /> �� ` Horizontal Well ❑ <br /> f �J Destruction ❑ (Describe <br /> .V destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED U Noe_ <br /> Domestic <br /> 1Q}RX <br /> Irrigation — <br /> �'s" Industrial ❑ i <br /> `C Test Well O ❑ a <br /> Munici ❑ _ Q <br /> WP 1 1(K ATION SKET(H — <br /> (5) EQUIPMENT tG VACKRotary ReverseCarbh. ❑ Air ❑ of bore <br /> other ❑ Buck tom — <br /> (7) CASING INSTALLER (8) PE TI — <br /> Steel Plaslee ❑ n t Ty of un ur seer <br /> )From D Gage or — <br /> ft f Wall t size <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes ix No ❑ tf yes,to deplh I It �^ T <br /> Were strata sealed against po�L� <br /> lluti2 <br /> tion? Yes El IntervalNo (4 Intal It �Y g <br /> Met6mllofxahnt., 51� IIQL �Tc 1� ► ::-j A i r e:ia.. I Z--[4 <br /> (]0) .WATER LEVELS I WITWiT F 1I#.II I I li 1% 'a 1 I Mir \ I <br /> Ik lithe 1 first%alt r if known it <br /> J t - ..,� z. .. . t ar irsk 9. the <br /> :luetdtnKlr.tIAfter%ellwtnplrtion <br /> 011l \1 11 1 1 1 5 rs <br /> %e 11 inti l I 1n j� If,.• I. rt.<u * % _ <br /> Jt.,t luurfr I I 11+,Ire �.Lt17 <br /> .. r <br /> •t.i. .At— 4t date J 1" It ♦.. ..s e a <br /> - <br /> h <br /> M r a s -. .. aP.14 <br /> �+ y <br /> i n. _ ! ` .s Ly L� -y-T--11 1 fin <br /> DOM rw/ratv 4 oft. `•« ADO.T.01aAL SPACE iS P4"Mg'G V5E NEXT GOMS>WCt►TivE4.Y mums veD FORM M rOi73 <br />