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10/10/2000 06:11 20964 ' a WESTERN ASSET_ PACE 02 <br /> DRIPM.Mad of WSW Ragawo", <br /> 3291 s Str"t <br /> 11aer01ento.CA 4aQta 777 <br /> OWNERIVREQUEST F"OR WELL DRILLER'S REPORT(WELL LOQ) <br /> Pleuse use the back of this Page so sketch the lotagon 'Ur your WOO. "Adequate Inlomlation <br /> must be provided Wove a search;for the w*q log W begirt, Give tea <br /> from doss streets. Show tandmIft cs such as schools. post ofltces, hlstae comic sties� I�vva s <br /> county roads; main streets,.etc. (ip dicste Noah an tt�a ske M). y ' <br /> Location Of wait(City and County) r ll e f t'{�►n�' <br /> Strout Address -c 36 <br /> ' Township,,,1� Range . $action 'S - <br /> (C1iy or Cftr�ty P%Qnnina DtFartrr Ot rjr b 1[4 Or 114 1!d Section <br /> ` i1W(ir Ca eEi;a t4 t4mtsir ibis I Ilan) <br /> Assessors Parcel Number(on-tax s,udementy <br /> (ItPoss'te.OOQ"stMM a copy of th#A:tsessaes Flat esl lubP. <br /> Subdivision or Tract .Lot No- <br /> . ��_ Parcel <br /> Owner wren well was drilled <br /> Other Previous Owners .,... i <br /> !A C,�,e <br /> WOO Drilling Contractor or Company,j2 V <br /> ---- —��. Year Drilled �w�r <br /> Depth of well Cd kpown}ligaUd zlAL,6y„ .01ameter&type of tasinq 6 " 7 <br /> (This infoimsUan is necessary If you I Swzl mors than or#rr@II.).. <br /> Seaton 13752 of the California W111tr Code permits roletiae of wetsr waN drillers re <br /> upon the written request of the a�►+nAr Of the well. The ownees certncat;on must be completedlyd <br /> I certl(y that t am tha Owroe�of the r, Please send a copy o!the wa <br /> da,�i� ter <br /> d above. ^ well <br /> drWers report to: <br /> ch <br /> +R <br /> 17 <br /> Name ' Campari. �� �' <br /> Ed wards Roo 4 , <br /> A,ddreaa '� Address <br /> tACU OA 9/rIQ (.10 <br /> CiHy. S W, and Zip core Clhr.Surto and ZIP Code <br /> Tetephona Nt,rrieer ------ 70 <br /> TetepMae umbar <br /> r . o, e <br /> f <br />