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<br /> local{ �c�!requirell]entsTHE RESOURCES AGENIC0R 1
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<br /> DEPARTMENT OF WATER RESOURES
<br /> WATER WELL DR[LLEjk4!A pQUn 1
<br /> r,�,l Pen„il N,,.nr 7�-2375- HEALTH 1 L� '.Atm!
<br /> DISTj.j1CT,,?rr tt'eIr S.”
<br /> (1 ) OWNER: Henry Stagntlro
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<br /> 6.116 Rti
<br /> (I 2) WELL LOG: T,KaE TrPUt�.2.�15:t. 215
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<br /> (ltl) WATER LEVELS; v titi-ELL DNIL[-ERS STATE\IE\T:
<br /> 1)rpth nt finl wn2er, if kru•,.rte• --lt- Thi- u rl Iran driflrr(III -
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<br /> awn fse FFI 7.76. IF ADDITIONAL SII FS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
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