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t <br /> QUADRUPbCATE STATE OF CALIFORNIA fl 1R <br /> Use to comply With THE RESOURCES AGENCY DO not h <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 075516 <br /> Notice of Intent No.Z✓-` S/ (' WATER WELL DRILLERS REPORT State Well No. <br /> Local Perudt No. or Date 1 — z ' <br /> Other Well No. 7 rs. lell 98 _ <br /> (1) OWNER: Namo I ,tC f� zfV14 (12) WELL LOG: Tota(depthZZZ9 fr. Depth of completed wnl(�=x. <br /> Addres 'Jr ✓i. t�� /'F-� �/ from ft. to ft. Formation (Describe by color eharacteq size or material) <br /> (2) LOCATION_OF WELL (See instructions): +9 r3� %L/ • w/ %� r <br /> Couvtyh;•./ .• , ,/ Owner's Well Number <br /> Well address if dilfdifferentfrom above <br /> TownshiP./^// C[I/ Range Sectio - <br /> Dutance from cities, mads, railnreds, fences,etc /a/ fi / r1.c - �y j �� _r - •,� <br /> (3) TYPE OF WORK: F-^New Well N Deepening ❑ <br /> Reconstruction <br /> I ❑ <br /> I Reconditioning ❑ _ - <br /> Horiaontal Well 0 <br /> Destruminn ❑ (Describe <br /> destruction materials <br /> procedures i s Item - •� `�,l /,: Fi / _ <br /> (4) PROPOSED <br /> Domestic - <br /> �l�/ Irrigation O <br /> 1�--I IndnsMal ❑ � <br /> ❑ <br /> _—CI✓6 C� HK six = z ' u ry L X11 <br /> Municip <br /> WELL LOCATION SKETCH Other ❑ — <br /> (5) EQUIPMENT: (6) GRA PACK: <br /> RotaD' ❑ Reverse ❑ ❑ N S' <br /> Cable Air ❑ er of bore — <br /> Other ❑ Eu kat L]] rum <br /> (7) CASING INSTALLED (8) ERFORA — <br /> Steel ❑ Plastic ❑ G c t Type cf pe r n or a of acme From T Dia. r F To <br /> ft. f in. Wall ft. s' _ <br /> SUM <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Year No ❑ If yes, to depth ft, — <br /> Wem strata sealed af�imt pollution? Yes ❑ No�Interval N, — <br /> Method of sea' 4 F- % `-11 Il I L i+✓T /r-r: : t— _ <br /> Work started 1 - L 19 Complet 1 <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth of first water, if known fL This well was drilled under my jurisdiction and this report is true to the best of ma <br /> Standing level after well completion p knowflada"rul bbelii . <br /> (11) WELL TESTS: SICNEgL/.-��--- ,./_-�`-X* '--/ <br /> Was well test made? Yes C) N.*, If yes, by whm <br /> o ? / (Well Driller) <br /> Type of teat Pump ❑ Railer ❑ Air lift ❑ NAMF� y:h•t �l ://<<, N�t L:L �!( ;L 4 f/✓ l= <br /> yth to water at start of [at ft. At end of tea fr (Penoq 6�^fr,or cnrpora[i n) (Typed or yrin[ed) <br /> rge. gal ❑ whom <br /> a? <br /> afthours Water temperature Address) -� /.. :y'. C•� p �. t <br /> r - <br /> analysis made? Yes No ❑ If Yes, by wh ? City Zip 9' <br /> ric Iog.made? Yes ❑ No ❑ If yes, attach copy to this report License No. .><. - Date of this report <br /> V.7-791 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />