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t <br /> �r ol�/fti� STATE OF CALIFORNIA Do Not Fill lis <br /> C@ORI �, •{� � TETE RESOURCES AGENCY �0 89371 <br /> • IFIfe wlth o DEPARTMENT O WATER RESOURCES <br /> File wlfR AWR CdD $T1s <br /> Sia -1C) WATER WELL DRILLERS REPORT state Well No <br /> Other We No ••e <br /> fit; cu 2 �-w-- <br /> 45h W <br /> (1) OWNER (l I) WELL LOG- <br /> Name <br /> OG•Name Mary Patino /Hart Electric Totat depth 1 It Depth of complerrd well 128 It <br /> Address 11100 Saticoy Ave• Formu,ont Describe b3 rofor,rbordcrtr,Stift of rntttrtal,dad Slrsetnre <br /> Sun Valle Calif. ft to ft <br /> (2) LOCATION OF WELL- LQ <br /> r-ouatY San Joaquin Qwmr s number dany 0^ Top <br /> o S oil <br /> Townsh'P Llan a aad stcttan T28 Rn 3-14 Clay <br /> IMtance from cities r911d, r0rpsds etc Larch Rd & Tr Rd 1 -•1 Sand <br /> 06 La c Rd -Wet of ,Trgcy Rd, 19-22 Clay <br /> (3) TYPE OF WORK (check): 22-2-1 Sand <br /> New Well N Deepening ❑ Reconditioning C Destroying 1] 21-27 Clay <br /> If destruction,describe material and Procedure to hent 11 27-40 S$a nd <br /> (4) PROPOSED USE (check)• (f) EQUIPMENT40-44 Clay <br /> Domestic :gJ Industrial ❑ Municipal ❑ 1 Rotary ® 4 –52 Sand <br /> Irrigation ❑ Test Well ❑ Other C) Cable ❑ 2-6 Cla <br /> Other ❑ b _68 ,sand <br /> (b) CASING INSTALLED. . ... 68-70— Clay <br /> STeELX OTHER If gravel packed70-7.1 -- and <br /> SINGLE a DOLIEWE❑ --81 Clay <br /> Gage Diameter 81 -81 Sand <br /> From to or of From To M-120 Clay <br /> ft- If Dram wall Bore ft ft 120-126 Gravel <br /> 126-135 Clay <br /> Sue of shoe ac Ord]r,.X, suenf 1t"V& peA <br /> pacnbe nrweldpd <br /> (7) PERFORATIONS OR SCREEN- <br /> Type of parfotareon or name of screen <br /> Perf Rows <br /> rrom To per per Size <br /> ft ft row fir In xIn <br /> it <br /> (s) CONSTRUC'T'ION <br /> CI•ss a surface Sanitary salt Ptondcd? Yes No Q To wbat depth 0 ft <br /> We+e any scuts snitd agmns pollungrr? <br /> YesQ No Q If yes note depth of Strata <br /> from ft to ft <br /> From it to ft�ry Work stsrtcd 19 •completed. I7 <br /> Varhod of us]iaRBentonite " WELL DRILLEIi'S S'T'ATEMENT <br /> 9 WATER LEVELS This well was drifted ander my lerudretro3t acrd this report is true to the best <br /> ( ��� of my knowtedgeand belief <br /> Depth at which water w3rr gin Cpand if kn-A fr <br /> r <br /> branding feVe[,tafon, rioter If knt}vrp� Fr NAMR <br /> x01-mg (Perron,firm or cotporat$on) (Typ_Drillined or prralrJ <br /> S randing fere!yfter prAd de>relopieX fr <br /> (10) WELL 'PESTS' Address 2500 TV[, Eumble Rd. <br /> \Yrs$pump use msde? Yes CI"`- No 3D If Ye1,by whmn7 / <br /> Id Rai/min with it drawJo after hes f SICKED] <br /> a rempenwa of water lyras a chemical Drrl!r)a[anal Sys made? Yes CI No �7� r� <br /> Wrs elxenc log made o[..e41! <br /> y"(3 Nn If yes attach copy Lwense No1.632-G Dated ;'-G_�_—, 19.._7_3 <br /> SKETCH LOCATfON OF WELL ON REVERSE SIDE A <br /> OWR las toev 968 A <br /> 1 2d 179 a 309.9 Wk Yale A.DSP <br />