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<br /> Iocalroquirernents THC RESOURcES AGENCY 7.
<br /> DEPARTMf_'NT OF WATER RESOURCES No.:()6.5
<br /> ' �.'` -,• i -':, � tr xis
<br /> 4\IrKcrgl r We .-- WATER WEIL DRILLERS 1 RtEa:POR'.T
<br /> PersntNDet' f1I 1,s- tMlcl-�7'rl]\r• _
<br /> ! L:,. ..t! _,!.5:(..��)thr/lYr•11 h 4_`.. _ '['"� F4+�_5f3.
<br /> p n (12) WELL LOG: Trwul Jrpth 88 R.Depth of n•mpleKd'wetl s ft
<br /> V�J� S Wolf
<br /> .' from fL to
<br /> Addrev � • .-.. H. Fnrmatinn I De..d en' n,Msr, rbaricrer,'etce rte irin` 5+v�"`%i="
<br /> `cl rr@RCS dm �! - t r�
<br /> 7.,p rr ' I
<br /> (2} L A? ON OR WELL - 16 1.1 ay rv'a
<br /> ((('�]�{{{��� ++ (Sec instrnetinas), 22 an
<br /> s Cnunq an Oa u n �}}��rr'.Well umber - --• �,_.?5,- s v
<br /> J• Banda 8
<br /> �;� � e LS ell addrns-if diHnm.
<br /> � t farm ahr•.vr _- -
<br /> F:.
<br /> r nwnll,f
<br /> P- Han a rare 'r
<br /> u •5er'tk ,�F
<br /> Corner a
<br /> �� 1)irte ce Fmm efllc�,nxlsdr,rnflmadx,Irntes,rt[._�• • _. - •,� ��_o
<br /> r
<br /> d r149 - 1b
<br /> ;Y
<br /> -.. '• Y$
<br /> fi (3) TYPE OF WORK, l
<br /> Weil Pf Deelseninit❑ rfrd
<br /> I
<br /> Rnymxtn,rtbn .. ❑
<br /> '._s Annr,slltinnWll []
<br /> Ftrsdznntal Weil ❑ - ,s,•;v
<br /> Ik•rtnrcHan ❑ fDerc e• -
<br /> elert 1 m matrrialx " """' - • _ 4
<br /> pn,cedurrr.[n ]tem
<br /> b
<br /> a f f i i (l) PROP05ED' rnT Y i
<br /> s - Dnmertic
<br /> feel fition
<br /> 1ndu.triaf' ❑ - ..r, ;3F- a.i'+.ri + -1
<br /> _ }}
<br /> +��:
<br /> ;'_ �� r `-'S r be !+ :•r Munleln - -:Vi es i.r
<br /> EL LOCATION bs(87'CH t7tker .. '-❑ - .� '�y• '.
<br /> N :94rik f9)-RQVIpMSNTI
<br /> 7 i. �7
<br /> �, Sf Cable (�
<br /> Y., x I G1her ❑ ':�:` _ Huckel Q:,I•• ran t
<br /> s` 1P,,,(7)-,,, : -,CASIPIC-INSTALLED, (81_pEHFn1tA I n I - - -
<br /> `Steel-Q Plastle "Cn a Type of 1rc r r•nf r[ree. - - •. + r 'Nd�y�' .�?"
<br /> T Dia. Cra r F To - ,$
<br /> ft
<br /> 160
<br /> L
<br /> r xlt4)'�VFLL SEALI :Y- ; ..
<br /> 1 h„fi5_
<br /> `r V War nrrFane rasdtary real prnvidedP ;ler -:'hu ❑
<br /> If ye to drill ft.
<br /> aF
<br /> F Wex'rtratr-sepled nRa[ml pa1lutinnP. Yea❑ Nn p'Interval -_ _- -.fi:" - _: k a ✓
<br /> Stanteeitl<e �9r r
<br /> :Y�t M thndtnf:ueaHnsl `--�-_ �-. � -ll'nrk,rlart � - l4��
<br /> h4 a =(IO} '1WATER LEVELSe 1 i
<br /> WELL DRILLER'S 5'I'ATETv1E�T
<br /> -x y'Deptli of flat'rt5rmier-;lf:know ft. Thlr well was driliad undo, m erlGdlttlon -
<br /> + ' �Slendiatl level aHer.ivrlle�1� krsnw]rdNr rmd b el. it f - rr►snrt tr lrne'yt elw brat olxasp
<br /> �r(11)';WELL','TESTS]' y Sscwn._ .� .\ Yti CL�Ct .• _.1i3r�v d" T xF,
<br /> +�ilk Was,weH tert made} ,.Ycr C µ1�1�, IF Yes, by whrrmP - t r
<br /> 'IYM-of test :Pump ❑ H.•t11�r❑ .AIr hIt❑-� HEN -1$RAhly OSi'--' b
<br /> :`•} 11 Depth;to water et rlort':nf�Telt—L_�_ft.... At esu: of text It - f Penna,flan,nr cnrp+nlfrrn) (Typed nr I rsnted);
<br /> iifylrnhSryle e._'"�,tal/min niter houre ._Water tnnperatus ,.,_ Addres • ° :. f iru. 3
<br /> Chnnlcel,a,salprb made?•.Yn
<br /> ❑ `-Nn lx If s,y, by ivhnmP
<br /> y�*'y{Vatelcetric.lottmadeP-�' YeiQ • Nn 1F yrs,nHarh ro Us thfs repast Llrense Nn _Date of thir_rrpnn
<br /> j l]wa toa ,nav +es` IF.ADDITIONAL SPACE: IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
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