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' ORlvINAI <br /> .WATER WELL DRILLERS RET Do Not bili in <br /> R <br /> file with DW (Sect,ow 7079 7020,7081,7012,Water Cod.) NO 44698 <br /> THE RESOURCES AGENCY OF CALIFORNIA ' - <br /> DEPARTMENT OF WATER RESOURCES e Well N0 <br /> '1� Other Well No ` <br /> (1) OWNER (I 1) WELL LOG' <br /> N'--et1 JO'r-n �• '�� l l Toul death 1 00 ft Depth of completed veli 150 it <br /> 4 Address 462- V-^ri of ld i Form—on Dnrr,hr by color, b--0r, r,ze of tn+errsof,end elructtrrr <br /> Ca l • it to it <br /> (2) LOCATION OF WELL J 4 <br /> 0 -� ,1 ,4 4` Rdobie <br /> Cavary S 2 n tJ O a,ft u^�ifn Owner ,f a number sty 4 Q ro.vr '� t <br /> To.ashtp Ratge Ind Section 1"2—tT`T R— 1r7—ESebV <br /> e+• ��t 44 6 et 1S' g Fair 'AZT <br /> D itlatcr from cmt, roads —1,osd, etc x,or a 31 `n' D j �'r1— 6 90 harri b_rown cl `7 <br /> ba ;, 1 /6 --ni • '!es. of Cha rrrv?-nd 1q SP i l ��, l Vr <br /> (3) TYPE OF WORK (check,) 88 92 Eravel Q — 111 <br /> New Well 1�5 Deepening © Reconditioning © Destroying © 92 10L 'nara ti r - v <br /> If destructson,descrsbe material and procedure in Item 11 104 1 1 6 soft-t- bQW '1 it <br /> (4) PROPOSED USE (check) (S) EQUIPMENT 116 120 Q -c- G — 1t! <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary ❑ 120 1 'sF area: t- -) !- r - <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable :0 1 'S — 1 hat, rt, rate v <br /> Other ❑ 11,0 160 <br /> o t,1 <br /> (6) CASING INSTALLED- <br /> STEEL OTHER If gravel packed <br /> SfNGLE,X] DOUBLE ❑ <br /> Gage Di2meter <br /> From To or of From To <br /> ft ft D[am Wall Bore fr. ft <br /> 0 1361 8 12 <br /> S,ze of shot or weLX` Sae of ertvel f� 1>— 11 \ f <br /> s ,a y 1-NL <br /> De,­be IDint <br /> Etat t n p —gar_.._ �_ � <br /> (7) PERFORATIONS OR SCREEN V V <br /> Type of perforation or name of screen <br /> Perf Rows <br /> From To per per Size <br /> ft ft row ft in min <br /> (s) CONSTRUCTION <br /> Was a surface snnttary teal provided? Yrs ❑ No ❑ To what depth fr <br /> Were any strata sealed against,pollution? Yes ❑ No❑ If ves note depth of strata <br /> From it to it <br /> From it to _f t work",rted 9-21 19 G Completed S-27 19 . O <br /> Method of stealing WELL DRILLER'S STATEMENT <br /> (9) WATER LEVELS rhe: well was drilled under my )urnitictson and this report is true to the hest <br /> G of <br /> my knowledge and belief <br /> u 6 <br /> Depth at mhtch vaur vas first found d known ft <br /> Jahn L Pcmero Jr <br /> 5nnd,ng leve[ hefore prrlorsnng If knavn it NAME (Person firm or corporation) (Typed or printed) <br /> Standing level after perforating and drveloptng it Rt. <br /> + . 3 DQ <br /> (10) WELL TESTS' Address l� - <br /> Pum ere made? Yes <br /> pt 0 No If yes by whomc'a, <br /> ? EvOn, C.-ill 5 320 <br /> t <br /> ,d g+]/min with 4t drawdown after he. [S[Gh EYs] <br /> L <br /> (Well Duller) <br /> Tempera[use of water Was a chrmtn[anslyvs made! Yea [3 No ❑ <br /> �'1 <br /> n <br /> War elec vac log made of well? Yes r-' No ❑ if yes stt,ch copy License No 1 272 nate 9—�5 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 i Rpy 9 63] 5639+ an 10 65 50M TRIP OA osP <br />