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QUADRUPLICATE STATE OF CALIFORNIA U f UO not fill ill ' <br /> Use to comply with THE RESOURCES AGENCY JAN 9 1979 <br /> local requirements DEPARTMENT OF WATER RE CES No. 085334 <br /> Notice of Intent No.��j����� WATER WELL DRILLERS ��UIN AI.B No <br /> Loral Permit No. or Date /"—•Y Way <br /> No. <br /> (1) OWNER: Nage Al Fonseca (12) WELL LOG: Tend depth0Yt. Depth of completed wel 274. <br /> AddressZ • rpor ^ay from ft. to ft. Formation (Describe by e.1m, charecte, size or material) <br /> City rMUP.Mcat tss, Zip 0 - 3 Tq soil <br /> (2) LOATIQNN OF WELL (See nstruct ons): '-r rs - /� SSand clay <br /> County IZ +r Owner's Well Number Well L - 10 Oa <br /> Well address if different from above center 10 - 1 Cla <br /> Township Range Sectio t.' 14 - Sa <br /> Distance fm c'ties roads, railm ds,fencesfences et ort tta _ - y <br /> north rot W. Rfpoa $d. Wes - c y s ren s <br /> rp way 2 - <br /> - <br /> SIR <br /> (3) TYPE OF WORK: 38 C g <br /> New Well A Deepening ❑ 3?J 61 <br /> Necnnstmctinn ❑ _ $g $ reg <br /> Reconditioning ❑ - a <br /> Horizontal Well ❑ Piz <br /> - <br /> Destructfon ❑ (Describe - <br /> 04 <br /> destruction materiels ^� <br /> procedures ., Item = V <br /> (4) PROPOSED Sg <br /> Ihrmestic C <br /> ti <br /> Irrigaon O - <br /> Indus'al ❑ <br /> %Well ❑ - $n <br /> ay <br /> g <br /> WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (6) CRA PACK: v3iras, M0 sand <br /> Botany ❑ Necerse No Sizc _ C Y <br /> ❑ Via" ---2b sand p� <br /> Ali Cable ❑ Air er of bore__._ _ <br /> Other ❑ Bucket ❑ mm 0 2 © t Fine sand & clay <br /> (7) CASING INSTALLED (S) PERFORA O - <br /> 1 <br /> Steel IJ Plastic E] C Type of pe n or'arena._ <br /> From T Dia. G r F To <br /> ft. f in. Wall f . ft. size _ <br /> 0 afl _ <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes d No ❑ If yes, to depth10 ft.Were strata sealed '[ pollutio ? Yes ❑ No ❑ Interval ff. - <br /> Method of sealing Work starte 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know t. This well .. drilled under my jurisdiction any this report is true m the best of my <br /> Standing level after well completion ft. know/edge uad,bails) <br /> (11) WELL TESTS: SIGNED `-7�/�,'ti�� ' :' fl:✓ ,C�,''�r � _': /i <br /> Was well test made? Yes J No ❑ If yes, by whom? Hsnnin (Well Driller) <br /> Type of test Pump Bailer ❑ Air lift L3NAME ReWdnRs Bros, Drilling C0.6Inc. <br /> Depth to ��waat�te/rres�at start of teat ft. At end of rest�t ,rea(cPer fi r, o corporation) (Typed er printed) <br /> Ducbarge-3Z —gal/min after hears Water temperature Address 3JC l 'Pelandale Ave, r rA <br /> Chemical analysis made? Yes No [T&H yes, by whom? City Zip '}�-j'pI� <br /> Was electric log made? Yes i No ❑ If yes, attach copy hr thu report License No. Date of this mpo <br /> OWR 188 (REV.7a61 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />