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lG1NAL. STATE OF CALIFORNIA Do not fill to <br /> THE RESOURCES AGENCY <br /> DWR DEPARTMENT OF WATER RESOURCES NO. 061310 <br /> WATER WELL DRILLERS REPORT state Well No <br />[y.f Intent NoO�Omut No or Date Other Well No <br /> OWNERName r (12) WELL LOG Total depth,��ft Depth of completed we / ft <br /> >Q s from ft to ft Formation (Describe by color character size or material) <br /> O <br /> ess _ J <br /> Ztp G d !r <br />)) LTION AVELL (See instructions)) _ <br /> _Owners Well Number f <br /> 1 address if iffere t f om above <br />.unship e7 lt'en>; Sectio <br /> — U� <br /> Lance from cities roads railroads fences, etc "� <br /> Ax;z _ / <br /> (3) TYPE OF WORK " 10 <br /> f New Well Deepening ❑ 1_� <br /> 4!4-11a 4r� -Ileconstnictu)n 13 — -1' G4 <br /> Reconditioning - Il <br /> Horizontal M ell ❑ ,^ <br /> Destruction ❑ (Describe <br /> destruction imaterials f� <br /> O procedures n Item V — i <br /> (4) PROPOSED — `�YC� -/11� 4 <br /> E <br /> Domestic <br /> Irrigation <br /> Industrial �` �� ) ❑ ����� �� <br /> r Test Well ❑ ��%— <br /> _ > <br /> Stock <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ — <br /> 5) EQGIPNIENT (6) GRAVEL PACK — <br /> tin x Revene ❑ ]es)d <br /> No ❑ Size <br />�iMe ❑ Air ❑ Diameter of bare <br /> r <br />)thtr p BIKkO ',] Picked from 7ta t <br /> CaSI\C 1'%STALLSD (S) PIrRFORATIO\S — <br /> el E I'11til3L _ Cnrrrete Cj Ti pe of perforation ur a17t f ^Lrten — <br /> 1 o uui I ri Dia C lc;e or From "I o Slot <br /> ft ft )n \N III ft ft S Ze <br /> S. f j — <br /> I _ <br /> 1 NN ELL SEAN. O — <br /> ,5 ^urfi(c NznitirN Seel proiided� Ies \o ❑ if Nes to depth ft — <br /> 1N ere c'r it i eceltd 'ii,amst pollution' les ❑ N) lntenal. ft — <br /> ethod --f ccalmms's Work started I9 Completed. S <br /> 0) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water, if knou ft This well was drilled under my jurisdiction and this report t true to the best of my <br /> Standing lc%el after well completion_ ft Inouiedge <br /> 11)-WELL TESTS SIGI.ED ' <br /> well test made? yes ❑ No ❑ If Yes'?b whom' r <br /> r (Well Muer) / <br /> ype ofNtest Pump ❑ Hailer Air lift ❑ NAM R <br /> (Person,,fi ,or co rsivtion) (Typ or ranted) <br /> water at start of test At end of test _ <br /> + <br /> _ al/lean after hours Water temperature Address <br /> =2'aly5r madEl p <br /> nis e? yes ❑ No If yes, by whom? a �t7 p m <br /> ele frac log made? ya ❑ ISTo C] If Ies, attach copy to this report License Nonate of this repo <br /> �m { <br /> pWR tab (Rtv 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUkA RMi r <br />