Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA O <br /> G Do not fill in <br /> THE RESOURCES AGENCY <br /> File with QWR DEPARTMENT OF WATER RESOURCES NO. 150839 <br /> %-c, of Intent No WATER WELAft /D�KILLERS REPORT Mate Well No <br /> at Femict No or Da05-132te /_ ¢',! Ro — Oa{ <br /> k�w/ <br /> f e Other Well Nod as4l <br /> ( 1) OWNER ha171e 12) WELL LOG <br /> ---- � Tot c]drptki-12-74 Depth of completed we111.25 Ft <br /> 11d'c+s_ 1 from ft to it Fonoition (Describe by color ch-imcter sue or material) <br /> 1 <br /> (2) LOCATION OF WELL (Ste instructions) 3n 44 Sand <br /> t.aunty— an 110 Owner s E'ell Number 1. 11 - <br /> Wtll rddres% if different from ibovc 2 Fine Sand <br /> Iu,vnxhjp 0 z=s R1nge Sectcun <br /> Dcbtance fruin titieb roads mdroads fences etc 116 - j 22 ` <br /> 27 Q1 <br /> . ,.` <br /> (3) TYPE OF WORK <br /> New Well X Deepening ❑ <br /> Reconstnutma ❑ _ \, <br /> Reconditioning j] _ <br /> Honzont-d N%ell ❑ _ <br /> Destruction C1 (Describe ` - - <br /> destrucnnn matenals and <br /> Procedures in Item 18) <br /> (4) PROPOSED USE - <br /> Domestic ( _ <br /> Irngation ❑ <br /> Industnal ❑ <br /> Test Well ❑ <br /> Stock O _ <br /> Municipal p - <br /> I ELL LOCATION SKETCII Other ❑ - <br /> (S) EQUIPMENT (6) GRAVEL PACK _ <br /> Rotary [ Reverse ❑ Yes L.L No ❑ Sez _ <br /> C chle ❑ air ❑ Diameter of bare 12t, - <br /> Other ❑ Bucket [] Packed from_ to <br /> t CASING INSTALLED (8) PERFORATIONS <br /> Steel ❑ Plastic CX Concrete {C, Type of perforation or size of screen - <br /> From Tom` DIa Gakedr From,\_ To CC .S1otU <br /> ft ft in Wall ft ft <br /> 1 - <br /> ` - PSI - <br /> (9) WELL SEAL - <br /> .,urfite sanitary xetcl provided; ]es [X No Fj If ves, to depth50 it <br /> Were strata sealed -igacnst pollution' Yes ❑ No C intenzL__ ft _ <br /> Method of realm Work t creed i9 Co 19 <br /> t10) WATER LEVELS NVELL DRILLERS SfkTE\IE'NT <br /> Depth of first +vwter if know rL ft Thos well etas drilled under ny Jurisdiction and s report cx true to the hest or my <br /> Standing level ifter well tumpletion_ it knouledgc and belief <br /> ( 11) WELL TESTS SIc��n 7 �yC�i�1 -rC <br /> 4V1+ well test mlde" Yes v No ❑ If yes by whom" (Wert Driller) <br /> Ty."e of text Pump ❑ Buler 0 Air lift ❑ N `kNIE Cal_ water Drilling Co. . Ing . <br /> Depth to wetter at start of test ft At end of test ft t Pemnn firm or cnrporation) (T+ped or printed) `— <br /> ' 4181ge--- al,nun after hour Water temperature Address 300 S• Kilroy <br /> eical cnalysis made" Yes ] Nn ❑ Lf les try whom" Cityll <br /> electric las mule? Yes ❑ \n [] [E >es attach copy to thu report License No Date of thix repo <br /> DWR lea ttteV 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />