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QUADRUPLICATE STATE OF CALIFORN I A <br /> Use to DO HOE IL in <br /> local requirements THE RESOURCES AGENCY ' <br /> DEPARTMENT OF WATER RESOURCES NO. 096721 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT <br /> State Well No._ _ <br /> Local Permit No. or Date 337 Other Well No. _ <br /> (1) OWNER: Name Walter Betsehart ''++AA ��/� <br /> (12) WELL LOG: Total depthJl�k. Depth of ego,:pletea .veullkLfr. 1l <br /> Address • fm fr. to k. Fumration (Describe by colcolor.locharacter, size n material) � <br /> • o - <br /> Gtr Zip Bard � <br /> I' i – 2 lila <br /> (2) LQ(A�TIQN�OF SVELL (See instructions): 2 <br /> Cranb. a`z•8 da 1118 Owner's Well Number <br /> Well address if different from above <br /> Township Range Section D 8 <br /> D'tance from cities rads, railroads fences,etc. S• Austin Rd*— – <br /> ai. south o1 HII 9g west s do02 - <br /> 95 <br /> (3) TYPE OF WORK: <br /> i <br /> New Well J1 Deepening ❑ <br /> Reconstruction ❑ – <br /> Reconditioning ❑ – <br /> Horizontal Well ❑ V <br /> i <br /> Destruction ❑ (Descri edestructio – <br /> pr..dmaterials <br /> proceuresr. in Item – <br /> (4) PROPOSED ��„ <br /> Domestic – <br /> IrrigatiorrO ❑ - .�•.... <br /> Industrial ❑ – <br /> n <br /> T <br /> well ❑ – <br /> Stl- – <br /> ��, <br /> Municip app – <br /> WELI. LOCATION SKETCH Other �AJ.ili – <br /> (5) EQUIPMENT: (R) CAA ACK: <br /> Rotary 2 Reven:e ❑ No Sia <br /> Cable ❑ Air ❑ r of bore – <br /> Other ❑ Bucket ❑ r fl t f 1fl <br /> (7) CASING INSTALLED: (B) PERFORA I – <br /> Steel ❑ Plastid Co a Type rf pe or a of scree – <br /> From To Dia. Ga r F To <br /> ft. ft ; . Wallft. ft. <br /> 0 11 160 80 - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yesm No ❑ If yes, to depth—SC—ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft – <br /> Method of sea' Work start19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: ' <br /> Depth of first water, if know a� ft. This well was drilled under my jurisdiction and this report is free to the best of req <br /> Standing level after well completm 12 fr, knowledge and <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ Na� If yes, by whom? Be"" (W'ell Driller) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME BD7,111in �-�1�.�= Tne* <br /> Depth to water at start of test ft At end of test w (Pers n, on, corporaM1 ) (Typed or pri ed) <br /> Discharge gal/min after hours Water temperature Address 3525 Pelandale Ayg__ <br /> Chemical analysis made? Yes ❑ No J1 if yes, by whom? CityZip <br /> Was electric log made? Yes ❑ No IF If yes, attach copy to this report License No. P90ail Date of this repart <br /> DWR 168 (REV. 7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />