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LNIKHL Ui,> lK1t_, I it f—fDUU I Ula- ! 1 UU 1=1 .4,) NO .U11 F .U1 <br /> STAT[OF CA4.IF0#MIA - Do Not F&Iu _ -> <br /> 7HE ftESOUtlC[S ACiiIrPICY .,% <br /> aRa91KAL DEPARTMENT OF WATER RESOURCES ANN ?73'$ . : <br /> �— tet.with DWIt WATER WELL DRILLERS REPORT Sate welt No <br /> Other V01 No "s `/•? <br /> ri <br /> OW R: WELL LOG r <br /> Tetal 4rrr4 ft. A r/r nF rn.n Itttd-.if 6 It. <br /> fw..wadnn: rn+fhr by « rlr.eclrr,rl�of w./nlrf,+r/rk+rl.rrAddCfu I <br /> 1 <br /> i FI-m le. it <br /> (2 LOC TION ell WELL: F CM <br /> Torn.hf. • - A <br /> ! . I <br /> D'stanct(rum ricin,roads,railroads,•tc, <br /> (3) TYPE OF RK (check)t i <br /> New Welf Deepening Q Recoridltion:na ❑ Nsttoying [3 <br /> ( dotrartlon,describe morerisl and prxrdere ix ft&"11. <br /> f (4) PROPOSED USE (cbeck): (s) EQUIPMENT: = <br /> Domestic 0,4t =rial ❑ Municipal ❑ Rotary , <br /> Irrigation ❑ Test Well [3 Other El C�II?le ❑ <br /> - Other <br /> (6) CASING INSTALLED: <br /> rreEl oTNiRt If gravel packed <br /> almaLa DOUBLE ❑-- <br /> 1-71 <br /> r <br /> Ciaac Diatnccar ' <br /> Frain 'Ib pf of From To <br /> (!, fc: Diam.' will Hare it. �. <br /> - <br /> ••-, <br /> frrr of,h..T..r well e r Sita of era0•1: ++ <br /> 17exribr sum ^ ^ r <br /> 7 PERFORATIONS OR.SCREEN I <br /> T ..f oerfan tiara sir wa.we e[-icreee <br /> s Ftrf. Rows _ ._... . <br /> From Tb per per SiXV <br /> row ft. in,x in. Post-It"Fax Note 7671 DBIg v I <br /> to From <br /> FCO Q Ce. /se.C./ <br /> Phone r Phone p <br /> 7Z3 <br /> -.(a) C0NSTttt;7C'tI0N: <br /> 7..a.urficr t.wiu. sal yrorid•!r Yaa o To rhes 1q.tlr (t. <br /> 'ore+an •serer.sited• r:�>t lutionl Yrs No L If Ytr,net.d ih It itrtta <br /> term fa.to ft. <br /> t <br /> t•mm !t.to ft, 1Pprk wartr If �Llata4 t! x <br /> st+ttrrt al„:tin O VvELL D AKERIVATE NT: <br /> 7'bir'tufk!;9�rd alydtr'my jarirdi�ti grrd f rr(rort if lr4r ro the 6rsf <br /> i (9) WATER LEVELSI a/my koobeuct. i <br /> pe tit at which rater wax fent found if►tarn It.ltandini.vd iwtam etersriw if known (r- NAM- <br /> vi4nj;pA Enrl after .rt++rain and i­4 ;a �r eFporatian) r rd VrIa edI <br /> (10) WELL TESTS? Address ' <br /> Was lLsMtr tett twarta? Yea❑ NO whom? S <br /> 1-- nt.lm:t with it.air wdera after AA- <br /> Was <br /> 1 (VPs F 'filly) <br /> T.tn ...erre W wuir was a efitlelq°nnal air .? Ytf No' <br />?�S ' ciettric la made of tell? Yn Nr .j aualke ,LiGIAL!'�ln� ✓d �DiLed , f9 '' <br /> X . <br /> -SK6Tr_H LOCATION OF WELL ON REVERSE SIDE <br /> a N HIH-asf0 i-it cOsl TRI t�D Oy <br /> 1 DWR 1Bh IhCV.!•t!? <br /> a } <br />