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QUADRUPLICATE STATE OF CALIFORNIA Do not fill in <br /> Use toccimplywith THE RESOURCES AGENCY <br /> iecalregairements DEPARTMENT OF WATER RESOURCES No. 145750 <br /> Notiee df Intens Nn. �ry WATER WELL DRILLERS REPORT State Well No.__ <br /> Iucal Permit No.or Date - --- <br /> Other Well Nn.__ _ <br /> (1) OWNER: Name BUnChl ft es (12) WELL LOG: Total aep h- ft. Depth of eompleted ws11390 ft. <br /> Address no • Bode 105 from (t. to ft. Formation (Describe by ealor, charaelm, size or material) <br /> Cm, iia • ip16 020 a <br /> (2) LO" OI�T� k F' LL (See instructions): 20 22 y <br /> Countyya 1l1 Owners Well Number <br /> Well address if different fvlm above 26 i5z <br /> Y ` <br /> Township Range5 'n <br /> Diabou, I S ties,�ifs,Arat a fe ccs.et� i Corse s. <br /> 70 tO <br /> 85 195 <br /> zAa , 85 <br /> sand <br /> (3) TYPE OF WORK: y <br /> New Well X Deepening ❑ <br /> Reconstmc[inn ❑ <br /> Reconditioning ❑ 1;2�75 <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction ateriels PW <br /> procedure., in Item y J <br /> (4) PROPOSED a / <br /> Dnmertie. ❑Well \�V/J ❑Sh WELL LOCATION SKETCH ONer ❑ C2a(5) EQUIPMENT: IS) GRA PACK: SallRotary ❑ Reverae E No S'Cable ❑ Air ❑ at of bore -3 9U Bluec ia <br /> Other C3Bucket ❑ o T. - <br /> (7) CASING INSTALLED (8) PERFOEA S:louvered j <br /> Steel* Plastic ❑ C Type of pe n arof scree - 1 <br /> z <br /> From T Dia. C r F To <br /> Et. f >in. Wall ft s' <br /> it - <br /> tie 90 Nl� <br /> (9) WELL SEAL: +�� - <br /> Was surface sanitary seal provided? Yes No E] If Yes, to deptbjl_.- ft - <br /> \Vere strata sealed I-]a aynst pollution? Yes ❑ No Interval R. - <br /> Method of sea' M Work start 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know This rcell was drilled under my jurisdiction and thi, report is true to the best of my <br /> Standing level after well completion_ ft. ksm ledge wrc{Gelie). i 1, <br /> (li) WELL TESTS: $ICNID I� Iles- -=�'`�'Q <br /> \Vas well test made? Yes EZ No ❑ If yes, by whom? Henn J14,1111 <br /> Tt Ly�YI)rell Diller_ ) _ Inc.Type of test Pump � Bader ❑ Air jut ❑ NAME r= Bms Dr I 1 Cp In <br /> •f <br /> Depth to later t start of tes a h. At end of tes H (yeryyn Grp, inti.pL 'y'peel or printed) <br /> �} t 7 Q� Add_ 352] r�1H 8 10 'Awo <br /> Discharge 3251 gal/min after-- hours Water temperate= = ' , <br /> Chemical analysis made? Yes ❑ N.:�FE If yes, by whom? r� 1 1 i �1`jCr r <br /> Was, electric log made? Yes ❑ N.* If ces, attach eopY 4,1 4 r -?rt "-Lie ate of this repo <br /> DWR lee (REV.7.761 IF ADDITIONAL SPACE ISN ED. US NEXT CONS IVELY NUMBERED FORM <br /> JANu 1979 <br /> I � <br /> SAN JCf',QUW LOCAL <br /> HEALTH DISTRICT <br />