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ORIGINAL STATE OF CALIFORNIA DO not fill in <br /> File With DWR THE RESOURCES AGENCY <br /> VDEPARTMENT OF WATER RESOURCES No. 154084 <br /> InteNo WATER WELL DRILLERS REPORT <br /> _Hurt u or Dtite Mite kVLl1 \n <br /> Other \Lell ♦o e'7 Q <br /> r l ) OWNER Ira -�latheny (13) WELL LOG 3'0 3571- <br /> 1064 �Joodla-Ld Ave Suite Totil dept ft Depth of completed well}' <br /> \itv from ft ks ft I ono dxen (Descnbe by color ch tr-icter Size or muen d) <br /> City Zip - I TOD Soil <br /> 3) YCAJION OF WELL (See tnAniettom) <br /> c,onnty a l o3({uln 1_ �3 i <br /> Owner, Vell Number - Sa-d A-d Cl— <br /> 'Will sddress if different from %hove 24303 S Patterson Pass Read - <br /> Township�'r a r V ._B.%nge S1 3 T _ 1 5 t ectio Sand aid Gravel <br /> 1]isiuice from cures roads railroads fences etc _ <br /> I60' — 671 Clay <br /> ' 76 i Sand <br /> _RSZOA� (3) TYPE OF WORK {3 <br /> i New Well M Deepening ❑ 76 t wf=ti <br /> Reconstruction 0 <br /> �x Reconditioning ❑ 294, 297 Sand <br /> �4 Honzontal Well ❑ _ <br /> rot Destruction I] (Describe 297+ - 3301 Clay <br /> destruction materials and <br /> g procedures in Item 12) <br /> (4) PROPOSED USE i <br /> N` i <br /> Domestic <br /> \�+ rt,atson ❑ _ t <br /> S Slnduna) G V <br /> T <br /> est bleu Cl339 t - 347, <br /> Greed Clay <br /> stt>ck p _ <br /> Municipal ❑ 347, - 355f Sand and small <br /> WELL LOCATIO\ SKETCH TaVe1 <br /> Other ❑ <br /> ci) EQGIPMENT (6) GRAVEL PACK 355f___ 370; Call <br /> Iintary [� Rever,e F- Yes ® N ❑ Size _ <br /> C shleLbINI-tetet Air ❑ of boreOther ❑ Bucket ❑ d from 5-01 tri 7► t _ <br /> r� CASING INSTALLED (8) PERFORATIONS _ <br />"teel ® Plastic C] Concmte`0, Tvpe of perforation or size of screen _ <br /> From To,--- Dia C gear Frort�Y L' To 51ot�` <br /> ft ft!:'71n Wall ft�� ft ` '`��'s�ze' _ <br /> 337*' 357! `3 I6x4 — <br /> 9) WELL SEAL _ <br /> Nis surface sanitary seal provided2 Yes� Vn ❑ If ves to depth��ft <br /> Nere strata sealed against pollution', Yes ❑ Na ❑ IntervaL_-Q- ft _ <br /> fethod of sealing y <br /> Work started -� !9Completed <br /> IO) WATER L7owe." <br /> ,T 11 WELL DRILLERS ST LTE\IE�tT <br />)epth of first wateft <br /> ' Thts well wa a render my runsdection tint! this report rs true tri rite hes, of rnJ <br /> t�nden� level after plft knneoted��fid chef <br /> 11) WELL TESTS Slur n <br /> v is welt test midL7 Yes Q No ❑ If res by whom, -0- (Well Dnllcr) <br /> vpe rsf test Pump ❑ Bvler ❑ Air lift p P�artln Pum & SLI <br /> icpth to w-tter 1t start of test -0- It `\-X11E` p only Inc <br /> -0- ft (Person Mitt or curpor'ktzon) (Typed sr printed) <br /> ��- gal/min 'tfter -�- At end of toot hour. Water temperature -0- kddress 5 Reed Road <br /> inalym made Yes ❑ NO If y _ 28kda1e ` 5361 <br /> ❑ yea h cvhuns _ City p Zip <br /> r� electnc toi, mtde" Yes ❑ No 7j If ties attach Lopv to this report -0- License No._- 360-S5Z n1-23-35 <br /> ate of this report <br /> WR 388 (REV 7 yet IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMSERED FORM <br />