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QUADRUPLICATE STATE OF CALIFORNIA n DO ROC rLli IYt <br /> Use to comply with THE RESOURCES AGENCY 1988(�' fill <br /> local requirements DEPARTMENT OF WATER RESOURCES' ? Ro., 086652 - <br /> 1 Notice of Intent No,— -- -- WATER WELL DRILLERS REPOR�N !;)P.G'J+,��1 L` 1�� O v J <br /> Local Permit No. or Dete� �EII LT�� er Well No. <br /> I <br /> (1) OWNER: Name Joe Byl•s• 12 WELL LOG: 203 2a <br /> 24%5 A rte ( ) Total depth ft. Depth of r, sh cte r well ft, <br /> Address fmm k. to k. Fomsatinv (Describe by color, character, size or material) <br /> c; a oa tCalif „p - an <br /> [`pT' <br /> 2) L(�''�{I��W (LL See instructions): 35 - 3 !a <br /> v <br /> Camry ”— OwneJs Well Number- 3 - oflr8 •— <br /> a-n4-Well address if different from above 103 an • <br /> Township Range —5 <br /> 103 LOS Z_ <br /> Distance from cities, mads, railroads,fences,etc. - <br /> ve <br /> (3) TYPE OF WORK: <br /> New Well 9 Deepemsig ❑ — <br /> fl Reconstruction ❑ <br /> f t Reconditioning ❑ cc <br /> Horizontal Well ❑ — <br /> { Destruction ❑ (Describe — <br /> destructionmaterials111)0 <br /> Procedures in Item — --� /` <br /> ?'I (4) PROPOSED p We CST • n6 a C <br /> Domestic on • e not responatoW <br /> i ( - irrigation €O \4jay a t remrnt n8 of thw <br /> r r — , Industrial\�\ ❑ ca• <br /> r \vv) <br /> j Mun;c; <br /> WELL LOCATION SKETCH Other ❑ — <br /> (5) EQUIPMENT: (8) GRAP <br /> rsACK: <br /> Rotary Aevee ❑ .� No S — <br /> Cable ❑ Air ❑ er of bore <br /> Other = <br /> her ❑ Rucket ❑ mm 03 <br /> (7) CASING INSTALLED (8) PERFO S: <br /> Steel ❑ Plastic C c Type of pe of scree <br /> From T Dia. G r F To li <br /> ft. f i . Wall f . <br /> IJ <br /> (9) WELL SEAL: rn <br /> Was surface sanitary seal provided? Yes No ❑ If yes, n, depth. .N k. <br /> Were strata sealed against Pollution? Yes ❑ No 11 Interval A, — <br /> Method of .."is Work started 19 Complet d *fvF1 <br /> j (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of lint water, if known This well was drilled under <br /> Standing level after well compl ft. ml iurirdictien nn¢ th' report is true to the best n) my <br /> knowledge and belief. <br /> (11) WELL TESTS: SIGNED j ) <br /> Was well test made? Yes C] No� If yes, by whom? r' PaII@ro 6Ia1( Ye'�r"�.` )lin Inc.Type of test Pump ❑ Railer ❑ Air lift L] NAME ' it g <br /> jDepth to water at start of testf. At end of test ft ) <br /> Discharge oat/min after firms Water I* Calif. 9536 _ <br /> 1 <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? Csty <br /> Was electric log made? Yes ❑ No E] If yes, attach copy to this report License No. Date of this report_ <br /> DWR IBB (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />