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' f <br />' ORIGI(dAL _ WATER WELL DRILLERS REPORT Do Not.Fill In <br /> File with DWIt 7 ' (Sectlaal'7079,70341,7021,7032,Water Code) O <br /> 7,THE RESOURCES AGENCY OF CALIFORNIA to&t 18383 <br /> DEPARTMENT OF WATER RESOURCES �s"`e Well <br /> Ocher Well No.- <br /> (1) OWNER-mI� (11) WELL LOG pit <br /> Nae California Water Service Co• Total depth $ 80 <br /> hi <br /> ft Depth of com ed well ft <br /> Address 2.0, BOX 1150Formattohr Drerrlbe 67 calor,eharreler,sisr of rnatenar,n+d ftraetssre <br /> S it to ft <br /> (2) LOCATION OF WELL <br /> Guoty <br /> Owaer'i pner if anyFr <br /> Toworhep Rene and Seetlon 16 r ' dS e <br /> Distanes 'ram cibe, roadr raimads etc d 2 - 40"Yellow sands, c1a s <br />' t' 40 .» 6 d s n ave <br /> (3) TYPE OF WORK (check.) 63 657,Hard gravelly tas hard an <br /> New Welt M Deep°mng 0 Recondrnon mg 0 Destroying ❑ 68 , Sands <br /> It dettructlon,describe,rnalerial and procedure in Item I I r. 10 5r,Yellow gravelly clays <br /> (4) PROPOSED USE (check) (5) EQUIPMENT: 10 tt. O+,Yellaw clays <br /> Domestic ® Industrial ❑ Municipal ® Rotary R 130 . tY clays <br /> Irrigation C] Test Well [] Other ❑ Cable Q Grayej Graveand sande <br />' Other ❑ 125 184'Vyell%1 <br /> (6) CASING INSTALLED- and <br /> STEELt OTHER If gravel packed 0 S <br /> SINGLE]K] DOUMLlE2809YeIlQu sandy clay <br />' Gage Diamcter -- <br /> Prom To or of Fr°m To El rw 431,Grave3.a6d sand <br /> ft ft Dram Wall Bore ft ft 43 <br /> 1 ,e f( Qci$ZLlf sandy clay <br /> Ir s3 0 - 5905Sandy blue clay <br />' n -5ilL, <br /> 1 00 — 57015Sandy blue C a s <br /> Spas of rhos ae well cin i Slrr of leraveie 11 X 11181, <br />' Deser,be pNM1L <br /> (7) PERFORATIONS OR SCREEN <br /> Type of perfaran°n or name of aexen Roscoe Moss Fu -Fla <br /> perf Rows <br />' <br /> From To per per Size <br /> it ft row ft sn x an <br /> 0060 �� X 811 <br /> 1 <br /> (8) CONSTRUCTION- <br /> V21 o eatfan ntutary real psoveded? Yet LIE No 17 To what dcpth 66 it <br /> Were any Strata rea1ed'p.1mr p0lution? Yea❑ No 0 If Ter note depth of■trata <br /> From it to it <br />' From it m it Work started 1 19 Completed 819 is-71 <br /> Method of eealm? WELL DRILLER'S STATEMtNT <br /> {9) WATER LEVELS: saw faf <br /> ied and my lnnsdsction and tbu reftort is trite to the best <br /> of MYArsowl g belref <br /> Depth at whteh water wu fist found of knawn it <br /> stand,n,( level before tgeforadits ,f known ft NAMEC M g A (,a <br /> Standmit level after peeforatm and dayelo eng it (Perms rm,or corporstron) (Typed or prinred) <br /> (10) WELL TESTS. Address CoUrt r\ <br /> IM <br /> MT <br /> tesr toads? Yes No If yea,b whom? g95 5b P <br /> Rat Imre with fe drawdown after hrs SIe <br /> Temperature of water Was a ehemtcal seal 1u made? Ytr[] No Cl (Weir Driller) <br /> • Wnr electric]413 made of well? Yrs Na( If es arrack copy License No J.. 6864B Date , 19� <br />' SI�ET�H 1_OCA?IOiY OF WELL ON REVERSE SIDE /1 , <br /> 1S" <br /> DW R 5 B a (REV 9 67) J mast 9so to as Boat�Alr(a A csr <br />