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ORIGINAL. THE RESOURCES AGENCY Do not fill in <br /> File with I)WR 0EPARTMIENT OF WATER RESODg��S <br /> i <br /> NVATER WELL DRILLERS RE RT No. 252906 <br /> Notice of Intent No. State Well Na <br /> Lscal Permit No.or Date 88-4 Other Well Na <br /> (1) OWNER: Fame (12) WELL LOC: Tataldepth-923 fL(:ompieteddq*h 10.0 It. <br /> Address from ft to ft Formation(Describe by Color,character,d9ror m.Z. sal) <br /> City__ F1 r3 n.:t a r a CA ZIP 0 – <br /> 9 Sind <br /> (2) LOCATION OF WELL(See instructfons): - 12 CIRY <br /> County S a n J O a Q[�_Owner's Well vnmber 7 – 14 1;a n <br /> Well address if different from above S n u t h l a n rff- A vlvlantI4ri JQ – <br /> Township Range Section 10 – <br /> Distance From cities,roads,railroads,fences.de. <br /> – 54 <br /> Austin Rei. — C <br /> (9) TYPE OF LVORK: 91 – <br /> y New Well EX Deepening tr1 <br /> 107– <br /> ' Reconstruction ❑ <br /> Reconditioning ❑ /t <br /> Horizontal Well ❑ 1,4N 1 O <br /> Destruction ❑ (Describe – <br /> i"+ destruction materials and pro- +` <br /> cedurn in(tem 12) <br /> (4) PROPOSED US _ l <br /> Domestic _ <br /> Irrigation Q <br /> Industria] O ❑ – <br /> Test Well ❑ <br /> hale <br /> Munici I ❑ Sand <br /> O er _ <br /> I <br /> - WELL LOCATION SKETCH < Ibe) – + <br /> _ I <br /> (5) EQUIPMENT: CRAY CK: <br /> nr <br /> Ratify ❑ Reverse <br /> table ❑ Air ❑ rte f bore r <br /> Other ❑ pucka from ' <br /> — � R <br /> (7) CASING INSTALLEIA {9) PER 71b.'KY: O i <br /> Steel ❑ Plante Ty of f tm_sized _ <br /> From T f Cage or t <br /> Ft. f i Wal] t. size – <br /> r n – <br /> 120 <br /> t <br /> (9) WELL SEAL: - on <br /> Was rurfrce sanitary rest pw"de, Yes (,� No 19yes,tadepth 2@-----ft, <br /> Were strata sealed agai rut pnllution? Yes G No ❑ rnterval ft. <br /> Method of seslin9. r f1 Pl Fl I I r T O R r A S T N G_C,P H F l T r n TN _I work started L)a n I 19.x$ Completed 19— <br /> (10) WATER LEVELS: WELL. DRILLER'S STATEMENT: <br /> Depth of!irst Water,if kno.n ft, <br /> IThis well was driNrd under my/urrsdtction and flier r u Inre to she i <br /> &andlralerel miter-ell complvtlnn 1_Q –It lest of my knowle and f>�g'1ir-f. - I <br /> (31) WELL TESTS: <br /> Was Weil lest nude. Yes Signed <br /> s [.� No ❑ If yes hr Whom? N F f 1 FI 7 Af(�� ;Well Driller! <br /> Typeoftnt Pomp [ BilrrG Air1!1 GG NA.,IE H€NNINGS BROS. nPTi I Tor, Com„-_-Nr__ <br /> Depth to v,.ter at start of test ft. E At roil of test fL I Yerenn,hem.or corpnnoo )(Typed ne pnoted) <br /> Dische atimin alter t.EI'- <br /> t rarurr Addren 1525 PFI N f)A 1 F A VF <br /> - <br /> '�` R A iAtl [•eons sT(L, ra 0 F;6% <br /> Chemical aruN made? Ys G No � 11­.L 4hum. City _ZIP <br /> W35 rlectne 1119 made Ycs C _No T 11 ars.otrarh enpv to rhei report License No . ZSL8 11 Date of this rc rt 88 <br /> owR Ida Irt9V. I2•4161 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM M 96377 <br /> i <br /> I <br /> i <br /> f <br /> t <br /> 1 <br /> � 4 <br /> F <br />