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<br /> QUADRUPLICATE - STATE OF CALIlORNIA - �nOt°L•}t�,r
<br /> Usefocamp3ywith THE RESOURCIES 4GENCY
<br /> Iota.requirements
<br /> DEPARTMENT OF WATER RESOURCES No. 1280.2
<br /> WATER WELL DRILLERS REPORT `"
<br /> NW fee of Intent No,
<br /> Stars Well N. �' s`f'
<br /> Lace[Permit No.Dr Dele± .e __i Other Wall
<br /> r.1) OWNI ER: N. ,.�aMSV MOst (12) WELL .LOG: TMe,dept 16 �-•,:.;�:;�6 '
<br /> a a. 5.Depdr a!nlmpktr!el wid e.
<br /> Acidnes fnwr it, to ft. Fnnnatlnn (Describe k., colt► character. ml*e at.naledfill
<br /> .:City - Si'a e•
<br /> -G(2nm)ty.'_ x� owner' zlr
<br /> I�TJ%.,jAVELL (Sct•inatnittrnt):
<br /> -- 20Gravel
<br /> rav!
<br /> �T 5
<br /> '
<br /> 2 - oto
<br /> r..-Wefliddraaa lid fnmt ohm's 7 7_ afem .. ---:�r .,1--' �''"�•' �•
<br /> -9'nwnrhlf" -
<br /> Src hery�..yyp}��
<br /> Dlt(ance fmm titter.road%railroads fencer etc f-. "'-- 'Qr :14 -
<br /> 'v �"qI
<br /> Rae
<br /> (3) TYPE OF WPBKc rcix a t>t ewe
<br /> - New Well4Z Dcepeninit❑ 161 -
<br /> i:earmsemctlon [] - - - t.ti. _ F•4z'^S'+n.,t.`tj�•IA,i,'a�w !u+w+
<br /> .. Recnndillonlru ❑ - - - ;ri•itl,.`:4h�fii y'➢`."'
<br /> . Ilorislmtal Well C]
<br /> Dk lnretlnn❑ (Describe - - .�' .. ,ts 'r.e•�5 •~ S'�"flehisC JsC.r
<br /> dertnertinn materials and
<br /> pmcednres in Item 121 - --� °',=;pca�',•..:�r;',:�! .S:•.; 'i `t -
<br /> R
<br /> (4) PROPOSED US - + t . s;
<br /> I71rmCllie -• .':'S .;^x.,s1',�.+t'!`�d�.s .a!7'i,R�•:.
<br /> - _ !rr(Antlnn;' [] - - •.t r.r MAX,''w�r•St�fP'at.�k'��!1
<br /> :�' �Y }4. 1, -.1 •:r 0 - .. :,Xr,1.r�''hL�'-➢iwex '.7E �'.y+71r%.
<br /> Indusltlal �•
<br /> - Test,Well t3
<br /> -
<br /> h~ Stock.'-
<br /> !-. il. d �`�*} ej. ± - �`'' INunkfpnl..,. ❑ r t :-1-`,Y' " - z
<br /> '.7111 VIILL LOCATION SKETCH Other ❑ - - .. -:a� ik�.. ,to?'At:'CYIdlY w i',iillltiY7'di.��
<br /> IS) 6QUIPHhN'CI - ?.- (6) GI:AVEL.PACKt
<br /> i. RotRrY' Atwaree Q _ Yn -- Nn�] 51 birdsaA ••, - _ x.,d�'„°L+1`"!�.Tar. ` a'e i
<br /> ,.
<br /> q?.Other ❑', .k „81ie1•e!- ❑ Pdclledfmn+:' t+ t. L S:f'tP ai¢?E�4�n3r3t6YApx
<br /> (7) CA81NC:1NSTALLBDr• i � ..' (8)''PSAFOAATIONSr
<br /> yi Slesl[] Plutie� CAuetete❑" Type of pertniston nr dze of screen S.$' fiS LiKi�T} s
<br /> Y is f S _
<br /> �; Fritm {:To f 'Dia: Cnxe or From: _ .To Slot
<br /> 4 ft. }, ft:C� `.in. Well ft. ft. size
<br /> t
<br /> > .e - ice acres
<br /> , ,r
<br /> 1(9) WELL SEAL
<br /> Was surface sanitary seal provided?. Y"�' No❑ If yes,to dernth ,. Q._„ft.
<br /> '^ Nero`at-ata ualcd almt -pally -uyrXii. Yes 0 ,. Nu❑ faterw! �..ft - - - - n•^r;.*.: r-*n,:w'�:�St1e3't�$T�rp!:�:5',��.
<br /> ? ivlNhod•o(:sealln¢ Y(3 ,ii7t Work sta lti Cam
<br /> (10) WATER LEVELSt WELL DRILLER'S STATEMENT:
<br /> t:I t)epth of'flrt:water,.lf known 4+F t! Thi,mdl mar drilW ander ms ferbdletfow,and thli reprrre b lW friths line° ayrri
<br /> r� tSlws1 after%4111compleHna '--- -' - R. knowfedxe and belief.. .
<br /> andlttQ-kt
<br /> LL TESTS
<br /> StcNEtt_ !Fl/!r/.rl t IJ.- Ill( ►/.,J ti.a`��IiCI'i Y s
<br /> S,Was'wel, test madeP Yes0 -NOR If yes, by whnms..r - (Well DTrig�s`ry�� �rI»t •N'q *n+t}h -1
<br /> Type td test - -.Primp❑ Haller❑ .Air lift 0 �e J a 'pro$. D 1n C6r fir` I
<br /> w NA,�fE;..._ ���
<br /> Delrlh to water fat.start of test... ' - Yt. �At nul of lest.�:�ft - "f P R nr cnrpnntMm (Typd or printed)
<br /> Add
<br /> '>Dtsaharltec •---nal/min after -'t!n110 Water tempershere
<br /> lChernleal onolyit...madeP Yea ❑ N0:9 tr yes,by whomP
<br /> Woi slxerM loa madeP Yea No X 11 yet,attach vary to this report Licerus Nn. Tkte tl th6 rr r
<br /> S own tee tltev.T.+ei 'IF AQOiTIONAL SPADE 19 NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM
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<br /> f
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