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STATE OFP'CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY NO 83990 <br /> DUPLICATE DEPARTMENT OF WATER RESOURCES <br /> Retain this copy <br /> WATER WELL DRILLERS REPORT State Well No. / -- -- <br /> Other Well No.-- <br /> (1) <br /> o. _(1) OWNER: (11) WELL LOG: <br /> Name T—A depth Lt^ (t. Depth of completed weu a. <br /> Address Formation: Describe by color,rbaaarter,size of material,and sf rurhrc <br /> ft. fa. <br /> (2) LOCATION OF WELL: <br /> county 0wne1'e Bamber.if,nY S Ith _ . <br /> Tovamhip,Range,and S.. <br /> _ P <br /> Distance(rote clues.roads,railroads, <br /> (3) TYPE OF WORK (check): ` <br /> New Wella(] Deepening ❑ Reconditioning ❑ Destroying ❑ _ <br /> If destruction,describe material and procedure in item 11. <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary �❑ _ <br /> Irrigation:P Test Well ❑ Other ❑ Cable ❑ r_- ;.,- Q <br /> Other <br /> (6) CASING INSTALLED: <br /> STEELY OTHER: If gravel packed <br /> SINGL,,o DOUBLE E] <br /> 1•__%� <br /> Gage Diameter —� <br /> From lb or of From To <br /> ft. _ft. Diann. Wall Bore ft. ft. i <br /> 1 <br /> Sine of,hoe will rine: $v. of¢ vel:) s eye <br /> "� r• <br /> Devniba iuim a - <br /> (7) PERFO�tATIONS OR SCREEN: _ �_ ' <br /> Type of perforasian or name of at 1. _ <br /> Per£. Rows )i <br /> F,em To per per Size <br /> ft. ft. row ft. in.x in. <br /> 1 <br /> 190 192 <br /> vxz—i Q4 <br /> t <br /> 264-214 a Ad <br /> (S) CONSTRUCTION: 214 ^ <br /> W.a surface aaniury ed provided? Yes ❑ No To whas depth G. •D <br /> Wer any a wled aaa: c pollus Yes ❑ No❑ If yes a deolh of n <br /> From it.an ft. <br /> From ft. a ft. Work carted 7_ 1 .Completed 19 <br /> mailmo of—1n, WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well w-as drilled under my jurisdiction and this report is tme to the best <br /> of my knowledge and belief. <br /> Wiest as which otter <br /> as first found, if known ft. <br /> Standing level beforeperforating. if known ft. NAMEF,, - j T <br /> Sand'n Ieve1 a(ce if.. cad developing r. fe (P....r,firm,ar orponsmn) (Typrd orprioeed) " <br /> (10) WELL TESTS: Addtess <br /> Wa pump tea made? Ya, ❑ No ❑ ff sea,by whom? <br /> Yield: aal./min.with it.drawdown after ho. [SIGNED] <br /> Tem f water Wal a chemical anal de? Yea ❑ N I We(I a Irr) <br /> Temperature ra,a L <br /> Wine Glee c Io made of well? Yea ❑ Nm If yea .ch copy License No. Dated E— 19�. <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV. 988) all,a-ago 9-..SOM TRIP In'p OSP <br />