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S <br /> u4 <br /> QUADRttrr.lt_"Te E� ` <br /> Llsn to comply with STATE OF CALIFORNIA JA!N Do not fill in. <br /> requirements THE RESOURCES AGENCY i <br /> DEPARTMENT OF WATER REVANR I IN No, 085319 <br /> •.K.e,+Intrn, .,,. WATER WELL DRILLERS IiBQiQj { plS'fRl��++'ellen <br /> 7 Other Wet]%''M <br /> (1) mvNER.- ..,,. California Yielding <br /> [ • Suppy (12) WF-LL LOC:;� n tar de"IL o8h. <br /> )rph rd rmplet7 AM , ed well- 80$1 <br /> rrie ' <br /> i <br /> fir rrraMrirJ <br /> zip so <br /> - <br /> 9 O����` �N{ 3. � <br /> ! ta !tr r r <br /> {', n TIU F LL (Sec 1nstnlctinaa)-. it a <br /> ! �_ tlw7+rr'a Well N%unhrr <br /> i Kell addmn If diflerh.t frmn atrrve ' <br /> i 'Fnwrrchip �I a �•� <br /> !tartar uror6 n' '� y <br /> n <br /> t]irtancr fnrnl ritlh, <br /> «d Jonx nr�,raiingxtc,{ena4 eft <br /> 1 Su <br /> i (3) TYPE OF WORK. <br /> \ew• Weil 9 Dr"wroina Q II — --•��..}§ <br /> Aecrmrtnrttkm � _ �� -- <br />#' Retrrndttkminu -- <br /> E tfnriutetal %%-ell _ ir6' • I1 <br /> Ih.tntctinn ❑ {lkre _ _ <br /> dlrntntrlkm mnMAak � <br /> } pnrrdurn in Item <br /> (d) PROPOSED J <br /> Q Jlrrt¢atlO ` <br />' Itxhlrtiorial Q \} <br /> 1J <br /> 9 <br /> +l'en 0 \ <br /> WELL LOCATI&N .511( 1 Other _ <br /> f31 EQ{JIt•►f6NTr tel CRAY ACltr _ �a <br /> e <br /> Rntary ii Fie.rrae Q No 5i <br /> Caw ❑ Air (] rtf fxae _ 1 i <br /> Other <br /> [] Rneket Q n <br /> M 71 CA3111C INSTALLEDe f A)'5iRF0JtA I 1� <br /> Sleet Q phae X <br /> it- Cn r I)Pr rel of re of w ik <br /> From T Dia. t,rt. r To <br /> fl. f <br /> 12. Wall ft (L _ <br /> A W S <br /> ( ) WELL E EALt _ <br /> 'I <br /> \\is srrrfara sanitary tatrl Dnrvidrd► Yr+1Z Ne 0 It Yet, flNr digp ft, – - •• ••` •.•""° <br /> Were mats waled a¢ainst pentltfnnP Ye.❑ Nn ❑ Ihterval fl, i '«� k <br /> \IMhnd r11 artlllny,,,,,,,� 1l'nrl starinl <br /> (10) WATER LEVELS: WELL 011ILLER'S SrX 'E\TENT: <br /> flrrtlh M fint wtltr►, if k .w,.– ft. Thio rrefl 11,04 drilled 11"der my hrrirrfk-tion find this rrtKrrt h !fire to the best n) mer t <br /> Stanaimt level after tern 04-Mioletk k"tp lrrfstd nm1 hrflrf. i <br /> r <br /> (I1) WELL TESTS, Srtmrn.._ <br /> Cat welt test madeP Ye+ G Nr.]KIf },n, NY whm%P 14'e!1 Drillarl <br /> Tvior ref test pump Lj Railer 0 Air Bit 0 <br /> NAME..._ H�1S_BTD� 1ZLf I <br /> 1Setrth to renter at start of hnt—ft. - At end! of <br /> tett_fl � Itm��ygrrtRxrt tl Yttr'd fir printed) i <br /> INscbar¢r ;ravmin sreer�_.-- rwyn Watrt tem mmre.t_ <br /> prr.tutr /� <br /> t:hr+nk-at snnhl fx madeP Yn C Aa If ve., by w•}w,m?_ Cite Kodestoo Ce• xl L <br /> 51'a+rletrtr/na mad,? Yrs \e TIrr,altarh tv vin Ilea n ret I.k•rnse Ian, w! ,_.__I7ph•r#1hh ^� <br /> own 1911 rRrV.7.701 IF ADDITIONAL SPACE 18 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 'i <br /> {e <br /> jl <br /> +I <br />