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ORIGINAL WATER WELL DRILLERS REPORT Do NOt.Fill In <br /> ' Filo wslh DWR (Seeereaa ye79,7020,70111,Boaz,Water cede) <br /> C) r THE RESOURCES AGENCY Ol' CALIFORNIA N� 44228 <br /> t`t L��'" r <br /> -`�Cj Q ©�, �€��� DEPARTMENT DF WATER RESOURCES <br /> �S. otherwdiNo - <br /> (11) WELL LOG: <br /> Name Total depth 19 vT it Depth of corn latvd well IT (r <br /> AddressrM <br /> Fast+on 37rterfbe by color cbersrter rima of materlcl,end rlrercissn <br /> r l� It to it <br />' (2) LCICATION OF LL <br /> County r Oraeras nwm6er rE xn <br /> Toworhip Ruse an sect-4 _ <br /> Distance Prean suis toads sat[roads,etc j y <br /> A34— <br /> (3) 'TYPE OF WORK (check): <br /> New Well `( Decpenuig ❑ Llecondstlorlulg ❑ Destroying ❑ 11 <br /> !t desirnriibn,describe Material and procedure in firm I1 <br /> (4) PROPOSED USE (check) (S) EQUIPMENT- <br /> Domestic C&Industrial E] Mumclpal ❑ Rotary �, <br /> Irrigation Q Test Welt❑ Other ❑ Cable v <br />�i Other 0 172 11ps <br /> (6) CASING INSTALLED: <br /> STEEL OTHER If gravel packed <br /> 6111OLE❑ DOu9LE❑ --- - - - ----- - - - - - <br /> Gage Diameter <br /> From To or of From To <br /> fr <br /> it Dram wall Sore ft ft <br /> Size of shoe er well brag t Sue of travd i <br /> Descrl6e loin <br /> (7) PERFORA'I'IONS OR SCREEN: <br /> Type of Petforatson or name of screen <br /> Paf Mows <br /> From To per per Sue <br /> £r. it row ft 1n x In <br /> (8) CONSTRUCTION: <br /> Was a surltce unitary seal rodded! Yn❑ No To wlrat depth it <br /> Weee:ray,trate.eakd aRarnat [luster? <br /> Tel IN No <br /> Fcom (t to �r ie <br /> cude Sao. <br /> From ft m It WUtic-tarred r-.40 19 ,Completed 19 <br /> methodaf.-Im 9!--.- WELL DRILLEWS STATEMENT <br /> (9) 'WATER LEVEL St Thrs well war drilled sender wary arerudiciron and thaw rrpori vs ;rue to the best <br />' <br /> o/my knowredge and bellet i Depth at rbac6 water was first Eouad,of 4aega fc <br /> 1 <br /> E Sranding level before p,t1c,ftong if known ft NA-MF <br /> 1 <br /> Standing level after perfor2t,dx and divelopeU IT {person,f rte,er corporat+oal (T ed ar prinled� <br /> (14) WELL TESTS. Address , !i a <br /> AMER PUMP tar made? Yes 0 No❑ If yes by whom? <br /> d oral(Mls, wrath it.drawdown after hra [SIGNEn3 <br /> ar <br /> (i7sli!]r] rr) F <br /> Tem eaeure of w:ta <br /> WAS a ci+cmtcxl analp.+a made? Yes ❑ Ho Cl <br /> Was cltccrtc log made of Well Yer ❑ No If yea atnch copy Lleesrre hlo�� ——D-P-4 , I9_�-_. <br />' SKETCH LOCATION OF WELL ON RF-VERSE SIDE <br /> Intl 910 10 65 MOM rpr!©A asp <br />