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QUADRUPLICATE 9TATR Or CALIFORNIA M not rill in <br /> use tocomply with THE RESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 11835 <br /> N. ,, `:G 7/ 7 WATER WELL DRILLERS REPORT <br /> .,,.— <br /> IAICAI rlrrrin Nr\er DAM <br /> (1) OWNER: Nnme �l L Llt �7t CICI (1E) WELL LOG: T,,t•1 deph21St.nrpth.a..nnRkr d . <br /> 'Jr `./ G fnm R. to R. F.nm.Nm IDeRTIhe orM+. a." rAe •x wuMld) <br /> J, <br /> L,r y <br /> (2) LOF WL (Smimtnwhow): _ N <br /> O,ytr �Y'!d VC'/i �/ /EA \\'11 <br /> iron.dd,nR If If .I.ne OM no°i rAAe r / <br /> 707 SHIT /t[/ <br /> T, Jdp R.nae <br /> DWrnm fnnn ckkc"*ds,nnnmd.,lens*•.eb tP!Pop <br /> QPDX < <CiMf r �Irt <br /> OF WORK, <br /> N— won <br /> ❑ <br /> ❑ <br /> � 7 Annnlitk.ninr ❑ _ <br /> ❑ - M/fi//1C Ce t <br /> �(I Dntmctfnn ❑ IDeRrR,e <br /> 1( dretrxrrwm <br /> MnawixN, in IINn _ Y <br /> (c) PROPOSED / <br /> Dmnnl{r _ <br /> Inia•n,m _ O <br /> Nlw.fr /z Mnad•1 O ❑ Cti9 <br /> Weill ❑ k/ <br /> �•E/TI[6S V[[1/q f/� O i'� <br /> I W61J. LOCATION 51R7C11 Other <br /> 101 Wgivino'l, ❑ - E hYC EL <br /> 1 �R) CAA FAC[, <br /> j RabrY ❑ ne.ene ❑ ❑ Nx sl - i 177[[- THN [AL <br /> G,hb M AIr ❑ .,Jh„M _ N(' cc75. <br /> (kh" ❑ RCMhn <br /> (7) CASING INSTALLED SMI .RPORA _ AJA <br /> OFA Q{ PI.•tk ❑ G Ty <br /> m.4 d - <br /> Ftom T Dia. C r F To <br /> (B) WELL SEAL, _ <br /> M'.r nIfu,•u,9.n'.e•I RnnidMl YIN Q!• Na p 11 m b <br /> N'en An. wlml .ralr p•Ilnlbmi Y. pp Nn�R 1 m• <br /> Mnbd .l .11, <br /> 11'mk W 19 (inn knM17— <br /> (10) WATER LENELS, 5� WELL DRILLERS STATEMENT: <br /> St d M Bru xxMr, 11 Ymxn Tht. rcr11 ,m. dr�ted,ruler rIMINbR.../ k n k tr.� m eM heR of �r <br /> (11)mt keel .Rer xell a,xn kt1.n iC FII /1IY////( PYF 1mxJ.dn nrd Arl y <br /> 111) WELL TESTS: e.ik. SIGNED <br /> T. <br /> '.. von N.r mde> re. � Le R fN,❑ Ah Nn❑ NAME.»IFm,f �7/t2t) <br /> TR•�d M.r 1'.�mr ❑ . �I�.J�%N / <br /> Ih,MA n. xfbr •1 .I.R .d <br /> t"—ft.. AI nJ M ,..e rtp.r•�,,0r�,rrpa npn•rknrl 1'ii'ped nr R.7 r� <br /> IAM•ne_ .J mfn niter �mn W.Mr tem Add G'/f <br /> RnNn <br /> I:inminl .n•h.l. m•dA Y, = N" �[ a .m, h. xn'xn? Oy C C .a+G-,e <br /> tY•..kaarM hr.m.dR Ye. ❑ Nn A II.e .Ruh. m th'. 'A Lke,w N. ^-b nl thk <br /> own tee ...Y ..... IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />