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L ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> R THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 071446 <br /> of intent No. WATER WELL DRILLERS REPORT state well'79 No. <br /> L.—i Permit No. or Date —j Other Well No©�tv6 E <br /> (12) WELL LOG: Total depth400 ft. Depth of completes] welh V ft. <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> 0 - 4 TO soil <br /> (2) LOC 'TIOI� OF�ELL (See instructions): 6 Shale & clay <br /> 6 - � Clay- <br /> Well <br /> County_ an _Oaq n Owners Well Number— 6 - 1 Sand\ . <br /> address if different from above <br /> 16 _ �. <br /> Township Range Section ay <br /> - n <br /> Distance from cities, roads,railroads,fences,etc.. Thornton Rd_ •*' <br /> cl <br /> south of DeVries Rd. , endta of road - - M.71 <br /> west side 5i - n ara <br /> (3) TYPEOFWORK: <br /> New Well Z Deepening ❑ /' 12� a <br /> Reconstruction ❑ — <br /> Reconditioning {] e'),— <br /> Horizontal Well ❑ — '� "JI <br /> Destruction [] (Describe \ <br /> J— <br /> destruction materials q;nd �' v <br /> procedures in Item r — <br /> (4) PROPOSED <br /> Domestic <br /> Irrigation� <br /> hulnstrial ❑ 241 <br /> T\e�VeII ❑ \)— a <br /> Stock` �7 - 2., �S-`�and <br /> biunictp 7/ /. lam( lila <br /> WELL LOCATION SKETCH Other ❑ 32 - :3-_3. Sand <br /> (5) EQUIYTIENT: xx (ti) GRA�F�ACK: <? — Cilay <br /> F)Rotary Reverse JOl 7'e�s x No Size Er ? �j San <br /> Cable ❑ Air (] i Ini t��\o of bore 2 - ay <br /> Other ❑ Bucket ❑ rb f3um _o 0 Ft - an <br /> (7) CASING INSTALLED: (8\) +ERFORA4Ft M - ay <br /> Stcel.x I lastic ❑ C r\et Type of pe Qrn'pn or ize of scree \s 370an <br /> Lay <br /> From To Dia. G g���r F o � To <� l� ni <br /> ft. ft� in. Wall ft. s:z - aFl <br /> �j 37o 40 <br /> (9) WELL SEAL: w - <br /> Was surface sanitary seal provided? Yes No ❑ If yes, to depth_—iQ—_ft. — <br /> Were strata scaled against pollution? Yes ❑ No E] Interval_—�tt. <br /> Method of sealingDee fa 1 Work started— "' 19 Completed 19 <br /> (If?) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known_ r� ft. This well was drilled under my jurisdiction anXm'e <br /> port iv true to the beet of ray <br /> Standing level after well completion 55 StB tc ft. knowledge and beef. <br /> (11) WELL TESTS: �j SIGNED_ cC -) uee I J- <br /> GVas well test made? Yes No ❑ If yes, by whom? Hennings (`Veil Driller) <br /> Type of test Pump [ Railer ❑ Air lift ❑ NAME Hennings Bro . Drill-ink Co• ,Inc. <br /> Depth to water at start of test ft. At end of test_ 109 ft (Person, firm,or corporation) (Typed or printed) <br /> , <br /> g2_693 1;a1/min after—__--hours Water temperature Address 25 Pelandale Avg. <br /> r ElModes��� (t �5��` <br /> + analysis made? Yes No (� If yes, by whom? City — to (In, Zip 5p6 <br /> Was electric log made? Yes ❑ No If yes, attach copy to this report License No Date of this report 4--�•+Cly/� <br /> DWR 188 lnev.7.76) IF ADDITIONAL SPACE 1S NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />