Laserfiche WebLink
QUADRUPLICATE <br /> Use to comply with STATE OF CALIFORNIA Do Not fill M1 <br /> local requirements THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 055347 <br /> Notice of Intent No. Sa S WATER WELL DRILLERS REPORT <br /> Local Permit No. or Date State Well <br /> Other Well No. <br /> (1) OWNER: _Nam%/y✓ Vim•/% 1/�/G E .+/ (12) WELL LOG: <br /> ,Ar Total depth ft Depth of completed wellft. <br /> Address 64 S t E ff/�/^/�Cft/ 71�� from ft. tofr. Fotmatinn (Deacnbe by color, character, size or material) <br /> Ci zip 15.7E1." p <br /> 2) LO ATIpN�F WELL <br /> ( `/C/1.^ ^/i C'///1t/ (See instructions): <br /> County— f 0".r'. Well Number <br /> Well address if diffe nt from above <br /> w _ /� —/J //77/✓ Tr �'�R.. <br /> Tonship �N Range Sectio /S -�O rs•�A/ 5 STl1�P <br /> Distance fytm cities, mads,railroads,fences,etc, "r4 <br /> 7Z5 <br /> r SSC _4W 9 c <br /> I f1TiC/i✓��n/ k D - cam➢ 5�ltio•ev ��t.+,l� <br /> (3) TYPE OF WORK: fp Q r "f7T ' CL <br /> i New Wella Deepening ❑ <br /> Reeanstructinn ❑ ;064_1 <br /> TJ1 <br /> 4 Reconditioning ❑ �/� r��H 5 /� <br /> Horia,mud Well ❑ <br /> K• tb` Destruction ❑ (Describe — O �/� SA <br /> destruction materials jolli <br /> ' Procedures in Item — /6//T— sloloff <br /> (4) PROPOSED [ <br /> A7XW15,r11 Domestic _ L/!;' � " I'll $ ,2 <br /> on -�" <br /> irridgaustri <br /> tiO ❑ �/ <br /> Inal ❑ - �f3 5F!/✓Q <br /> T Wen ❑ <br /> Stoc Jam— .� C,SE D!�/"L �//✓/-� <br /> MunicipEf <br /> — fjeE�� <br /> WELL LOCATION SKETCH Other ❑ — <br /> (5) EQUIPMENT: (8) CRA AGK: — <br /> Rotary ❑ Reverse ❑ ❑ No Siz <br /> Cable A <br /> Air ❑ rot bore <br /> other ❑ Bucket ❑ m a — <br /> (7) CASING INSTALLED: (8) PERFO . <br /> HA I — <br /> Steel,p� Plastic ElCo a Type of pe or e of scree — <br /> From To Dia. Ga r F TO <br /> ft. E i . Wall ft. ft. <br /> f - /7 /e - <br /> (9) WELL SEAL: 1 - <br /> Was surface sanitary seal provided? Yes 1J No ❑ If yes, to depth S_ R. — <br /> Were strata sealed Inst pollution? Yes ❑ No fy intervai H, — <br /> Method <br /> of sealln 5�t!� C 1T Work st rted I!)_ Completed — 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know, �� -----ft This .,,Il cons dgq1ed under my jurisdiction and this report is tom to the hest of my <br /> Standing level after well completion // ft, knmcledge and eBel. (� <br /> (11) WELL TESTS: Stcven ;MA-pt / � /_1 K_P_ _J <br /> Was well test made? Yes ❑ No 4 If yes, by whom? � I,(W 11 Dr/ill" , / <br /> Type of test Pump ❑ Railer ❑ Air lift E] NAME `/ / I'I� !✓ 7)/`J/L'C-/11/e/ <br /> Depth to water at start of test ft. At end of test N LRera firAe, cnriion) (Typed or printed) <br /> DiscLarge_ gtd/min after �[hours Water temperature AddressfG��1 ./ <br /> Chemical analysis made? Yes ❑ No �p If yes, by whom? City f- <br /> Was electric Ing made? Yes ❑ No X If yea, attach copy to this report License No 3 3 7" Dale of this report <br /> DWR 188 (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />