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ORIGINAL 1 .. :�I; ' ' VAIIR WELL DRILLERS REPORT �TDo Not Fill In <br /> u1�I <br /> File with DWR 1 y� (L<tinnr 7079,7010,7091,1062,W. r Cnd.) O 18034 <br /> t/HI �q�4 J THE RESOURCES AGENCY OF CALIFORNIA Stare Weil Nn. <br /> DEPARTMENT OF WATER RESOURCES <br /> yy rr Other Well Na_ <br /> (1) OWNER: l (t1) WELL LOG: <br /> Name - T,n.l drvth f,. Um.h al mmvl...d.dl It. <br /> Addreu It <br /> Formuioni Dnnlbr b1 color,rb.nrtn,'I.r o/m.nrbl,.nd.nvl.n <br /> f, <br /> (2) LOCATION OF WEL : <br /> eonnuy u. mbe,.ir. — <br /> ioan.hiv.R.n ..rod Sec".. i -'3 <br /> Dan..re r,.m aidn.r..e.,ndro.d,r1r." IgeR LAare aeG �D � PFd'EL. <br /> mAVIN m LQel1fGSA.W w - 3 - c%�/ C <br /> (3) TYft OF WORK (check): W-SdAG 0A -0A0 - • e - e 4- <br /> New Well Deepening ❑ Reconditioning ❑ Dertroying ❑ Sya[.E tfClT' <br /> li dnf"clion,describe~arid and procedure in Item 11. /C1(Y//*. <br /> (4) PROPOSED USE (check): (1) EQUIPMENT: /jd0 !Gw - '455 E CI <br /> Domestic E] Industrial El Municipal ❑ Rocary ❑ .r slE X~4,& <br /> Irrigation,24"t Well <br /> El E] Cable 'Er - - D i c <br /> Other - Ta AF <br /> (6) CASING INSTALLED: _ 8 CIAY <br /> REEL: OTHER: If gravel packed - �/ - li I F <br /> rINOL[�DOU lLR - y- G� G <br /> .. 1 9 -54, 109N <br /> Gage Dismeter ./ O y—J (7 xwd< 6 - // <br /> ' 4From To or of Fram To <br /> it. I. Diann. Wall Bore f[. f[. 0- OFC der <br /> O <br /> y Q <br /> or <br /> Ha.J.b...09th do Xs em....if <br /> Deitruot <br /> (7) PERFORATIONS OR SCREEN: -t- l <br /> Tir..Jwforssl.r.r mm..!6rl. <br /> ft,(-A <br /> " do ' IIKe1s <br /> e/ <br /> Peri. Row, <br /> From To per per Sia - P <br /> it. 4f. roa it. in.a in. - S� �.✓� <br /> —J1 <br /> 39 `� bf-310 <br /> (B) CONSTRUCTION: <br /> er...nrh..ueiur .ol m.ldrd) Yn ❑ No Te abs d,lb !t. <br /> Wenn unu nd<d. .inn l.tiont Yn No❑ II a eau de th of arm - <br /> from (e... M1. ✓3i - <br /> p.mn Wort mord U .'Completed - If <br /> Nn bad of wun O 1� N® <br /> WELL DRILLER'S STATEMENT: <br /> Thit well w., drilled ander my lurhilklion .ad Ihil rrporf n it., to the hese <br /> (9) .WATER LEVELS: - of myknnlulydgeendbrfie/. <br /> I�h M.b af . .firs res Ir bm It. r <br /> S:.n/lnl b•d b.l.., pd..0n a it bon n. NAMit ,fur <br /> pmAln le.rl .leer ,l•nnn .nd dnrl11. <br /> (10) WELL TESTS: Addr... RrrfPl` kD <br /> Wu lap en,.=W Yn No U n,b .bmt �d6t <br /> Nd .7 ..1./men.duh h. o.n. n hn. $mmo <br /> . Tm, r.earr d..w <br /> Wu.ehemied and d.mJd Yn No , (Ode Orl r) <br /> v.uiutrlc le ~cele of.del 1w Nn If y'...—Th ropy Iicenre Nn. 1!(-2// <br /> C-47- at-o/ <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> r+wn Ian .,._ n.nI <br /> .n.., ..,. .. . �•. <br />