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WAYS OP GAU A <br /> ORIGINAL Mite AGOOLacao ^=NC7 DD ow BA <br /> RN with OWN DEPARTMENT OF WATBM RESOURCES <br /> WATER WELL DRILLERS REPORT No. 313825 <br /> Nalinr of IMMI Na %b Wt$fila <br /> Lanai Perndl Na or Date &-I $r 4r-9i OtbaWe6Pk►-----�--- <br /> (1) OWNER. Nam (12) WELL LOC Tuts)depe6 _rzC�opEelad <br /> ( A4drowfrom ft to ft Formation(Dtsreribe by=by aim 0SlAft <br /> city zElWawa' <br /> ' (2) LOCATION OF WELL(See instructions} <br /> s � <br /> Opunly ,Adw �•� Owners Weil Number <br /> or vc <br /> %pil ua1 1.4m if diffrvent from above <br /> Townrhtp t- <br /> 1)istamr town sit lea,novels.radnwdk fl tars,rlc .1dau gas <br /> 1 <br /> ) <br /> 111 TYI'F OF WORK � <br /> Nrw Well ❑ Dorvening ❑ <br /> IlrevrnsUuclNm ❑ t <br /> Rtronddionmg ❑ <br /> fiorlsuntal Wel! E3 2^ - t <br /> h� D strudion 0 (Describe <br /> destmadion materials and pro- Ar 1 <br /> g endures in Item 12) <br /> Ulf r (4) PROPOSED US _ <br /> -t klf, Domestic <br /> L trrigatinn <br /> Y lndusiriai r <br /> Tort Well ❑ l <br /> '� Mansel ❑ _ Q <br /> WELL LOCATION SKETCH be) <br /> (s) EQVIPMENT CRAY CK 1009-7 <br /> Rotary ❑ Ikvarte ❑ No ' <br /> Cable [3Air Elof bona <br /> Other ❑ rom ` I <br /> (7)W INSTAMED <br /> steel © Pladie %g Ty d ord3wof <br /> F`r�rn f Gz > <br /> =ie 36A POW <br /> (9) WELL SEAL. <br /> Wai rm(wa auatory asst pnwkiod? Ya Na❑ It yer,to depth— ��'r Fe <br /> F <br /> � <br /> Ware Erato sealed apift palhdlanP Ya❑ No illi loterval fL <br /> Meib d of mbr4g Work started "' l9 <br /> } (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water.if known. _FL <br /> Thi.* umll was drdkd under m ju and rrport it tror W ck <br /> Standin;level diet well completion It Lett o/my dge and belief <br /> (11) WELL TESTS Signed <br /> Was wet!kd rRade? Yea ❑ No❑ If yeaby whwn? <br /> Type of ted Pomp C3 Railer © Air(ifl ❑ NAME <br /> Depth to water at dart of led It At^nd of ted It f irm— l 1 <br /> Duchat{e pi/min after—houn Watertamperatum Addr <br /> Chemical analysis made? Yes ❑ No❑ 1I yea by whom? City21p�-- <br /> � warkctnclaltmade Yeti El '40© If ytsacl+ to this LlcenseNo1-%11 IV 0lfteaftlataprt <br /> DWR 1¢ A40ITIONAL SPACE 89 NEEDED USE NEXT CONSECUTIVELY NUMFWALO POAM a► <br /> I06 IRN 5a•ebl <br />