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QUADRUPLICATE STATE OF CALI FORN I A <br /> ' + <br /> Use to comply with THE RESOURCES AGFNCV JUN 5 1979 Do notffll'A <br /> local requirements No. 052187 <br /> WATER WELL- DEPARTMENT OF WATER RESOURCES <br /> 148820 DRILLERS OUIN L(X,AL <br /> Notice of-Intento.�. —79--346Cte ell No. _ <br /> Lra:al Permit Nn.. /9 <br /> or Date " " H I IS TRfsather ell No. <br /> (1) OW RR: S.m (12) WELL LOG: <br /> 1 To[al dep h ft. Dep h of completed well k. <br /> Address from ft, to ft. moa s by color, character, size or material) <br /> - <br /> ip <br /> (2) L '19��r ^�ry f ELL (See instructions): too Sand <br /> County "�Y Owner's Well Number 22. <br /> Well address i r A g� rmve at fn abo <br /> To.hip nanRe��ectlo - <br /> 1'1 G p <br /> Distpn<e f�rgy�tied.L lgi lyradll � a - <br /> /l�iri'v �Ll� 1J j <br /> clay and sand <br /> 144 14 gaird brown.-.592111 18 <br /> (3) TYPEzOF WORK: I AR/y 172 anti <br /> New Wel] ❑ Deepening ❑ <br /> Ra,,aeuuctton ❑ - <br /> Recnnditioning ❑ - <br /> H.Hi ental Well ❑ <br /> - Destruction ❑ (Descri e - <br /> } destruction materials <br /> procedures in Item - <br /> (4) PROPOSED <br /> Domenic - <br /> Irrigation O _ <br /> Industrial( ❑ <br /> WeII ❑ _ <br /> T S <br /> i eam RGt responsible <br /> r._. _ _ MIInIfIP - <br /> WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (.8) GRAV ACK:Rotary ❑ Reverse ❑ ❑ No SIF ' <br /> Cable EF Air ❑ r of bore— <br /> Other <br /> ore Other ❑ Becket ❑ mm <br /> (7) CASING INSTALLED: (8) PERFORA I ' <br /> - <br /> Steel � Plastic ❑ Cu a Type of peAAk.,zarze of scree - <br /> Froin To Dia. Ga r F To <br /> t. i r. W ft. ft. - <br /> (9) WELL SEAL: - <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If zyyes, to depth t <br /> f - <br /> Were strata sealed against pollution? Yes El No Q- Interval ft. - 473—j 4/19 79 <br /> Method of sealin Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if kno 41■ ft This well was drilled under my jurisdiction and this m,,rt is tore to the best of my <br /> Standing level after well completio k. knowledge and belief. <br /> (11) WELL TESTS: = Sicn•Eo p�_ y a.p�t}� <br /> Was well test made? Yes ❑ No ❑ If yes, by whom? Panero WelleMitilingj IAC• <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ <br /> NAME <br /> Depth to water at start of text ft. At end of test ft <br /> Discharge oEl/rain after sous Water tempemhme Address_- GaIIQai calLf. <br /> Ci �,33!1 Chemical analysis made? Yes ❑ No ❑ Ifyes, by whom '1. <br /> YjiEt�j <br /> W. electric log made? Yes ❑ No ❑ If ves, attach copy to this report Licenn No. Date of this no <br /> DWR 188 (REV.7-7e1 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />