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STAT!Oi CALIPORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not fill Ni v <br /> File vi4; ,.VR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 257287 <br /> Noticr of 1 w•`?lo_ State Well No <br /> Lnr.. P<Tmit No.or Cote Q- LS"7 6 Other Well No. <br /> -? OWN R: N.me CNF ON SA IIJG• (12) WELL LOC: Tocol depth 2Zo ft Cwnpleted depth I�'.ft s <br /> A•.+;m2 '� NIrjO P'r= (- from it to ftForm.tlon(Desenbe Iry t; Ior character,size or m.terW) <br /> City...rJ'A �" Q CJl-__zip 9 _ O. ✓0.v ``d� <br /> Q _ gat- olw t lke <br /> (2) LO�CAAT�j)ON OF WEIa.(See imatmctions): — Qa 1•t w.o <br /> County��'OaVII-1 Owner's Well Number w (` --'�.p C�4 tM's ILAw;'-SQL. ✓+ � <br /> 9 ,'. IrgSIoN 43). '3q u7n, U <br /> Well addrw If different from. <br /> Township -r2 5 Rang< �-P<eti`ry <br /> Disonce frpm cltiez roads railroads,fe ces e a <br /> N site- �-<�e+. 10 «� <br /> arses 0•/ - l 51 <br /> (3) TYPE O�A,,F(( K: <br /> WOR <br /> KY <br /> New Well Deepening ❑ its+ �• - <br /> - t <br /> Reromtruction ❑ <br /> `O Rernnditloning ❑ -- ,.~ y <br /> BgN7.p„ Horizontal Well ❑ <br /> Qn fur}V Destruction ❑ (Describe <br /> r-J rL TE destruction meterieb and pro- ^"` - <br /> ccdures In Item 12) <br /> i <br /> (4) PROPOSED US . <br /> I� Domatic - t` '•�s may,. �. <br /> Industria `/C�\\- ❑ "`P�ycab <br /> ~' Test We,: <\v ) ❑ o- �.'',y""°"' -v, <br /> e Munici `/ -❑ - <Z> �'NC <br /> - WEIY LOCATION SKETCH ibe) - <br /> (8) EQVlPMENT. CRAV CY- I ' <br /> -_ Gby ❑ Alr ❑: es dbve <br /> — <br /> (T) CA l G V+SrALLEDll <br /> , (8) PE Q - . <br /> Sreei C .. PWtk 2r TY d o' of <br /> From - Of Gageor t. <br /> It f Wall t- size – <br /> (9) WELL-SEAL,' <br /> k W u ad.re n.nsou d pmadedt_.Yes�, No❑ If yer,to depsh I-S IL - <br /> - Were sr. �PI�VVBuV°.^I. Yn ❑ No IQ Imam.[ ft. <br /> I.lethodda11n6 Workst.eed O 19 Compkf :fl_y.a. <br /> (10) WATER LEVELS. . WELL DRILLER'S STATEYIENT:-. 1 �r r <br /> Depthdfl,,er•Ifkro FL Tho well was drdled und.m my !I.cU•!tetbn an 1 r �-\w to try L� :{ <br /> 5tardleg kwl.ne.•R+Immvk" �7 8 T=r ;'^y <br /> it y.,rt of my knowfedee and b" .16"1 ; '.. <br /> x <br /> (11) WELL TESTS "' - �/j- $AI(7. 11•JO signed <br /> Wu•eelltesenude7 .: Y - Nn❑ If ye.byhem7 Ao-u); ❑ NAME SPFGrauf9- r,r?(.o2A�, or� I /V'C <br /> Trped:at Pant B.Ikr Z 5 ty�m�,pR`°�.f�w)ITYTl cr+atedl <br /> Depth la�kr Sl npyt dla.A � rL: At nd f ttl jig rt 'J •7 G ` 1 <br /> heun W. , p.En AJdreasl�O l� S105- <br /> Dheh.:e_s• cry STDG if N - - e^ nP . <br /> ya yes s � G (0 24 <br /> Cheminlunly.ls made? Yel✓$� N.❑ If b bm Llttnse Nn �1f � Datedthu <br /> y, ek.r.fcl male Ya ❑ Ne IfYa.Ibchro ml <br /> Wu ... <br /> 1/ A OTONAL SPAC! 19 !lDIO. USE N!%T CON3lCUTNCLY NUMBERED FORM <br /> Owq IM tftP- ta211 <br /> l <br /> Yj� -"gasF tt <br /> �4u1 l.�s# s ywL�>Yy <br />