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F O <br />ORIGINAL STATE OF CALIFORNIA <br />THE RESOURCES AGENCY <br />with DWR DEPARTMENT OF WATER RESOURCES <br />wTXtent NoWATER WELL DRILLERS REPORT <br />it No. or Date <br />Donal fill in <br />No. 081700 <br />State 6Vei1 Na <br />Other Well No O & �r 99F 01 P <br />�., OWNER: Nnm �� �o / /'A <br />, Total dep t. Depth of completed �calt='e.ZEt. <br />(I2) WELL LOG � � <br />from it, to It. j7ornintion (Describe by color, chtimcter, size or material) <br />kddresg <br />�ity_tW t'i. 7.fp <br />(2) L CATION—OF WELL (See instructions): �q <br />11 i�./e , <br />County, 19 n _i 1C) �M��Owner's Well Number <br />_ <br />--740' ' � <br />S(7! <br />J �% / n+ ►2 /�6( f!� <br />t <br />0 <br />"W <br />'2W ' C <br />fZYQ <br />- � ham_ <br />i� )_ <br />{Nell address if different lrom above`� <br />Township hang Sectio <br />Distance from 'es, oad , railroacbw fences, etc �pt ° <br />Pyh; _ _9 <br />to' /}� ;/e �� l b e"L <br />OLtI bt s rIG .S f�1') <br />1177 jJjj^^^^ / <br />jJ 1� <br />gs <br />�lT� <br />o <br />(3) TUB OF WORK: <br />New Well'f. Doepeniag [I <br />Reconstruction ❑ <br />Reconditioning 0 <br />Horizootnl Well ❑— <br />Destruction ❑ (Describe <br />proceduon materials <br />res <br />prxedures In Item <br />(4) PROPOSED <br />Domestic <br />Irrigations\ <br />\\\ <br />Industrial ❑ <br />e t Well � ❑ <br />S <br />Sk <br />hfumcrpc � <br />Other ❑ <br />As <br />— <br />�/ ^ <br />_ <br />— <br />O <br />_ <br />^ <br />WELL LOCATION SKETCH <br />(S) EQUIPMENT, <br />Rotary Reverse ❑ <br />Cable [► Air <br />Other ❑ Bucket ❑ <br />(a) GAA FACKt <br />❑ No Size <br />I <br />I ter of be <br />a <br />— <br />— <br />(7) CA NG INSTAL1fED: <br />Steel 7 Plastic; Co c et <br />(B) ERFORA Ygi�(S: <br />Type of per OrNsize of scree <br />From To Dia. G, r <br />ft. ft in. all <br />F oTo <br />f .� ft. <br />t <br />siz <br />(9) WELL SEAL:/ > �� <br />SVns surface snnitary seal provided? Yes (6 �NN 13 If yes, to deptlt._Z_o ft. <br />Ivare strata settled agninst pollution?) Yes B• No ❑ Intgrval it <br />lfetbad of sealin s " Work starte 9 Complete 9- <br />(10) WATER LEVELS: r� / WELL DRILLERS STATEMENT: <br />Depth of first water, if knawn�—ft. This tveU teas dr -MV render my ' risdicti and this report fs true to the best <br />knotvledq`�rZ1_/bV tol- `J <br />Standinr level after well compledo , c ' � k t� <br />(11) WELL TESTS: U ' Icty <br />1 ;) <br />1VAs well test made? Yes No ❑ If yes, by whom? L/ � (tv <br />.ype of test Pump ❑ Boiler ❑ Air lift NAMr Z <br />tepth to water at start of test ft. At and of test,,._—_. -.ft I]? jun, Arm, or co��ottl�) (T or <br />c Address <br />A 0' O <br />avrain after ours Water temperntar 1� ��/'�G` <br />,/ City, �GGZ " 7— <br />r analysis made? Yes [j No yes, by whom? Date of this report <br />.Jas electric log made? Yes ❑ No f�}' If yes, nttach copy to this report License No .32Q.263 <br />� <br />owR fes (Rev. 7.7e) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />0 '/V o9 <br />.3 1�E'c®or'QlS <br />N <br />�f/ <br />