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At <br /> r'- n atE OF CALIFORNIA `F <br /> ? <br /> THE FESOURCES AGENCY Do not fill in � <br /> ORIGINAL <br /> ., (( File with DVdR DFSPARTMEn�' OF WATER RESOURCES <br /> h, WATER WELT DRILLERS REPORT No. 257288 <br /> 31 Notl!e of Intent Na --_ State Well No <br /> Other Well No. <-t Local Permit No.or Dam :.} <br /> (1) OWNER: Name rHEVgc-r� USA INC, (12) WELL LOG: Total dept �'2 it.Completed depth�it <br /> Address 24(•o CAhI tN0 P-4 MO N _ from(t to ft Formation(Describe by color,character.Am or mat 1) <br /> cRy'4nl AM�n/ cq __ZIPg4�3 0 - Z S,wd cha =we ✓tw c�r�c <br /> A � - 7 Sal ai0. ✓pwk <br /> (2) LOCAT.ON OF WELL(See instructic W) �u <br /> County5A� ]o'q'Q4( t✓ Owners•.Jell Numlxr W Si tAna iLtw 94u t ✓ <br /> Well addl:m if di((erenl from aboF�7.��.Kq- a, ��. AN'I'R C'/} S - .F2 (ACP <br /> w� itA.•: uvlC b✓Dt-tN <br /> _ L _ > p >ns.d trowtn <br /> TownshipT2S Range 6� $G .ioG `LS - Z6r rpw to ' <br /> b� Sc <br /> Dtrtanc_from citiex rcadx railroa fen et _ <br /> I�S$o 12D_ 3io v_, $E 5 t - <br /> i <br /> _ 3) TYPE OF WORK: <br /> New Well K,. Deepening ❑ <br /> Reromtruction ❑ <br /> k <br /> �p A <br /> 'Reconditioning g ❑ <br /> V Han...W Well ❑ <br /> FnL,Et. \ Destruction ❑ (Describe <br /> Y _T.,�ezr)t destnlction materials and pro- <br /> cedar.in It..12) <br /> t fel (9) PROPOSED US <br /> /N Domestic - <br /> / 3, Imgction <br /> Industrial <br /> r• �9J- -- x.f $ Test Well ❑ -_ <br /> - uy Municti 1 ❑ _ Q s <br /> er No L"O�rnKT <br /> Wk1L LOGTION <br /> (S)EQUIPMENT. (g7�G.,RrAV CK <br /> Rotarp❑ Poser» ❑ No - i - <br /> .•hh1. ❑ Air.- ❑ v .p(MZ is ZS. <br /> quGeaothar m Reck <br /> (T) GSrNG INSTAIJSR ts) PE11 T1 <br /> Std ❑ - Pisano rypsd onorsimd _ .. <br /> From T i Gage or t - - <br /> ft f - i Wall t size <br /> (9) WELL SEAL: <br /> Wy md.m mmluy s.Ip.sWed7 Ye). No❑ if Ye•Odepth Z•'J it - <br /> WareRnuRaledrOinR Ilatbn7 Yes ❑ Na,� lmerval ft - <br /> Work started O O 19 Com let.d 19 Y <br /> t Mahod d,ntirlg ? . <br /> - -(10) WATER-LEVELS: WELL DRILLERS STATEMENT: <br /> ' tkphditrst..ror,Rkno.n It The urell k ,ledg. under my.JlnbdlelWn and this <br /> 1 <br /> StardlrR lend aiter.A manPletbn Jr EJ R Lrst of my know(rdge and fxlle. (✓` <br /> t (11) WELL TESTS: E�' ✓=..J 4, 1 u Signed Wyi on Nr) <br /> W.sraRtotm.de'r Yes Yf� No C3 1r Yom,rwrhom' �j PFG7''Qut-I f=kPGor2 cTr orJ c)Je- <br /> Typeftm aaannn�����,P.m R.iler (3. Airlift L NAME <br /> Depbroarf,JJ ✓�-�"t ntendd tat-SS'= -R o 1pGrson(I or r(p[o�7�p/on)TYP'a er4atedl <br /> � `� Address Zy 7 `�" W Y7 - 51 <br /> Disclurge Ain it r Man M'etar peramr e. F Z O <br /> C/� Ij ,_ L..,,1 , 51 C�GC TO/�f ZIP <br /> GMminI.IMIYaN mala? Ye ET No ❑ IfYa by.Mmi 1 - C�''s' p <br /> _ Waseleceric lnq made Yes ❑ No� IfYaaeach mvs•tolhis nro, License Na 02- Z Dateo(Ihis report t <br /> j -�DTONAL SOACE 15 NBEOED, USE NE%T CONSECUTVELY NUMBERED FORM y aWr <br /> f WR tea raw. 12-M <br />