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lift STATE OF CALIFORNIA DO 1101 fill 111 <br /> THE RESOURCES''AGENCY <br /> load req=0 M1 DEPARTMENT OF WATiR RESOURCES No, 199749 <br /> DRILLERS REPORT <br /> WATER WELL DRIL <br /> `4sYice of Intent:�4,' i State Well No. <br /> i <br /> Local Pemvt No..or Date AS C^"X 6 3 <br /> Other«'ell No. <br /> (1) OWNER: Name r, (12) WELL LOG: Total de,r - r <br /> E l h d. ft. Depth of con- we117?_ .1_ 5ft. <br /> Address from;ft. to ft. Formation (Describe by a)lor, character, size or material) <br /> City---mrldeato RA- zip 4i — k <br /> (2) LOCATION OF WELL (See instructions) <br /> County } Owner's Well Numbe 'A!E Well address if different from above-26200 Afilwall Rd.47bQrnton 2 —4.5 S?MY STL,T�t.darkbLyraa.� i <br /> Township I Range__ -_Sectio ,•5 — � <br /> ---------------- <br /> Distance from cities,roads, milruads,fences,etc, <br /> 1 .ri]� '' dark YelloWiSlh brMm <br /> r, '�� <br /> (3) TYPE OF WORK: £4 c,T-` `'M.AYr <br /> b't]un IS iSt <br /> New Well pe m N Dee 'sf <br /> nin <br /> 6 ❑ <br /> Reconstruction ❑ _ `� <br /> Reconditioning ❑ — -' '1tt1ed darku <br /> Horizontal Well ❑ _ � t�Qr3.�,lr <br /> A amd <br /> Destruction ❑ (Describe <br /> I destruction materials and <br /> procedures in Item 12').' <br /> (4) PROPOSED L7S - \ \SI <br /> Domestic <br /> Irrigation ❑ <br /> �r Industrial 0 - KLMED_\ - <br /> Ttst Well ❑ ti�` V- 1 C?'g-1 and light 11rawnish cmay. W at <br /> St <br /> WELL LOCATION SKETCH ''Otheft1Ck1314px� 71t N. <br /> (5) EQUIPMENT: (B) GRAVEL" P_ACK: <br /> !1 \y_ 3 Y'er <br /> Rotary C] Reverse C] Yes.9 No ❑ Size <br /> Cable [7 Air [� Diameter of bore ' G" ( <br /> Other is auger Bucket [] Pltcked`from�___- m <br /> (7) CASING INSTALLED: (8) PERFORATIONS <br /> Steel �. <br /> El C� Cete nritr \4 <br /> d'� Type of perforatibn or size of screen,.' <br /> From To. Dia. G gt or Frotl To ,510 <br /> ft. ft. >fin. Wall ftp, ft. size - # <br /> 22.5 0 <br /> {� * - <br /> i '�� �.�\ •-fir,� -' * �j(o <br /> (9) WELL SEAL: 1 - <br /> Was surface sanitary seal provided? Yes 'ate No ❑ If yes, to dept T`.,ft. — <br /> Were strata sealed against pollution? Yes a No ❑ Interval-* — <br /> Method of sealin' oetmnWork i start 19 _ Complet 19 <br /> (10) WATER;LEVELS: WELL DRILLER'S STATEMENT: ,rte <br /> Depth of first water, if know $. - r <br /> This well was drilled under my jurisdiction rend this report is true to the beat of my <br /> Standing Ievel after well completiori__-_ ft. knowledge and belief. <br /> 1.(11) WELL TESTS: SAGNED <br /> Was well test made? Yes ❑ No IR If yes, by whom? e - (Well Driller) <br /> Type of test 4 Pump ❑ Railer ❑ Air lift [} NAME <br /> Depth to water at start of test k. At end of test--------ft (Person, firm, or corporation) (Typed or printed) <br /> Discharge gal/min after hours Water temperatureAddress <br /> Chemical analysis'tmade? Yes R No ❑ If yes, by whom? City-I' s � � Zip p <br /> Was electric log niade? Yes F) No 2; If yes, attach copy to this report License No .4 324' nate of this report �f��fK3 <br /> n i <br /> DWR 188 (REV.7.7re IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> �I <br />