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QVADRUPL16AT'E STATE OF CAL;FORWA DO not fill In
<br /> Use Of Comply with THE RESOURCES AGENCY
<br /> local requirements DEPARTMENT OF WATER RESOURCES No. 249214
<br /> N,-tite„r Intent No.—__.__-- -- WATER WELL DRILLERS REPORT h'tatr 1t'r11.\o,
<br /> D.n:nl I'rnr,ft Nr,, or Datt_�����'� _ O+her 14e11 No,
<br /> F
<br /> (1 1) OWNER. --Gary Z'a lla rd ---- (12) WELL LOC:. 'r..t.,f deptl, �4 ft. Depth of(Yrrthtow w etLikkt.
<br /> A from ft. to 17, F„nn.uhnr I IN—rihc by er,lur, chararter, iter or mnterfal)
<br /> t:it, Q►1V�cc3�K1A—_-. —�ii,�1� �_ -_ 10 Ls'lndy LOU
<br /> CunotY—+�� . ,...n,art•lntrrru'sc\fueolils\:umber-_ �__ moi fAl
<br /> d77l
<br /> (2) LOCITS � ( tc11 40 GlIIv1Q`
<br /> Well add. +. if different from nbove 0 - Z ` 0nd -
<br /> j T„wnship ltnny;r
<br /> Section42` 2 - 54 UaY - ----- '
<br /> Distance fr,m cities, mads.milr,n N.frnr�s,rte ! isCBt O - 66 ,,hael
<br /> 66 - 72 3and
<br /> south side 72 - 80 clay
<br /> (3) TYPE OF WORK: A r, -
<br /> Nu,v Well& Dret rnfnr ❑ 90 - SiZ ianila
<br /> fl r,,m,ruvlion a 2 - 105 Shmal
<br /> Itrc+,nditioninc ❑ 105._...._ 106 �sad _-
<br /> I(orituntN Well 0 106 - 120 -'iby el
<br /> Mh tmctinn 0 (Describe nd
<br /> 120 - 1 �+ •�M
<br /> destme0m nrateriais and
<br /> pr„aedur� in Item 12)
<br /> (4) PROPOSED USE:
<br /> Teit W01
<br /> Imtintinn ❑ -
<br /> j Industrial ❑
<br /> St,wk ❑ - -I"
<br /> I - I
<br /> MunieipnS ❑ �.1
<br /> l WELL LOCATION SKETCH Other ❑ -
<br /> rS1 EQUfyyP\LENT: +6)SSGRAVEL PACK: :� Il
<br /> Rotary Ia Rewnr (] Yeti is Nu ❑
<br /> ' Cable 0 Air ❑ Uineler u! IT t
<br /> 1 I
<br /> Other ❑ Iberket C Packed Fnuu_ ;e_L�'1�t�i.
<br /> (7) CASING INSTALLED! (f;) PERFORATIONS: � I
<br /> Steel Cl Plastic Cr„<rete [� Tc),el of perforation or«ize of screen
<br /> From To Dia. Gage or From To Slot -
<br /> fI, ft. ikr. Wall ft. ft. size -
<br /> (9) WELL SEAL: -
<br /> tl'as wrf,tce sanitary seal p-rided? Yes1'�r ❑ If 5'r dupth�5-0—_ft. _
<br /> N'em rt Mlu sealed atiain,t pnllminn? Ye,0 N, C. z il ft. -
<br /> ]Irth,<I of ,ealin' �ry R'-1 +uvtrJ,-. 9-- ti:nutplNat IB +
<br /> (10) WATER LEVELS: WELL DRILL,Elt'S STATL''\1F.\T:
<br /> Urpth oI fiat rater, if kri w-� It Tirir et•tf mor driHrd ..dr rnrr Nrrirdtdiun oral sl,is rcF r i, rme ro the best nl ,nV
<br /> It. knr mle•dCr .end hrrir•i.
<br /> Starulinc trcrt nfeer ,cell c mplrtir,n_. -
<br /> (
<br /> WELL TESTS: Str.Nr.0 I I} 5'r a •L ",1'e!1 Prillrri
<br /> 11'n,
<br /> -I] te•+t rrruS�? .N. .!} IF se, he w}�. ur_� _r
<br /> Trp,r r•f tr.t P,mgr �. Hailer❑ Air lift ❑ - i?I 'ii IR
<br /> Depth hi ,cate•r m rt.rrt -d rot _- .. M end ..f 1-r-_ h i 1 en�rn.lin nr cn gn,ratiurr 1 ( •S'prd ur pnntnlf
<br /> . �• �' n t
<br /> 525
<br /> tt'.ete•r frog„-nherc Address_]
<br /> Diatd,arcr_ cul:min altrr��._hr�"n r•,(s •r,
<br /> yep "33517
<br /> 0
<br /> [:it).-�•.r,:.S�.I Y_#...-
<br /> t:ht•tnira: nnwly,ir m.,,ir- 1'r. 84
<br /> C
<br /> .uh•: 1'r �] N'� t,.rhis r:iwe l.iccs,r Vn, G iwl.�-- � ryI
<br /> E)u!e of thk rrW,r st
<br /> DwR :0.0'r-acv 1.7- IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM -
<br /> I
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