|
I
<br /> . i QUADRUPLICATE 'TATE OF CAUFORNrA
<br /> Use to comply with THE RESOURCES ADENCY
<br /> DEPARTMENT OF WATER RESOURCES DO not fill fit
<br /> local requirements
<br /> WATER WELL DRILLERS REPORT N0. 2]082]
<br /> L n-1•of 11R..it N.N.. ---
<br /> Lrcal Prrrnll tin..rt Id1h. SIaM Well Nn
<br /> Wrll Na. __
<br /> (1) OWNER: Name 9thrr12 —
<br /> Add, —.11199 1 7190 IV O ( ) WELL CLI. IAC: Tolxl drp111�-It Cnmpletal derAh_o.
<br /> CIIy_ T.v}{ r 7 i f Irnm ft in fl. PnrrnaiHvl IUr•sr.tlR•hr minr I •t 1 i 111
<br /> r 95 _
<br /> (E) LOCATION OF WELL(Sec Inst nl01ials): 35- 1y
<br /> Cnunly- C.... 1n { Own.ri Well Nnr,d., _ i�-�T=Tt Cl✓A'�'
<br /> Wvll addn•ss if dllfrrenl frntn alrrvr 3S - 45 y___ •p y� �t�
<br /> T.wnshlp 4W filing, 617 �f}` iCKI1 C1iijT
<br /> Dlslanec 6Cm eiflrs,nude mllrwdx,fenmx vlr.
<br /> - —ft NO of l.am – i Opp, 0
<br /> 99
<br /> _ n spa
<br /> .J
<br /> I (3) T1'111-. Or WORK.
<br /> Net.-Well ffdIhrpeninp ❑ - 15S '•iL 7 u{ y } a rl
<br /> ag
<br /> r ,J .r wtyi lit„I1.r:mr..un, ❑ F
<br /> ,rm
<br /> •� ,'v > -i
<br /> C. 1I i'a f.e•-� i u Innn lu II I 1 ., �—��r- s
<br /> (d) PROPOn,:D U'S _ —
<br /> / _
<br /> IAX%ATION SABT(flf (\`} rirvv �✓ /.,, J
<br /> 1 (5) EQUIPMENT:
<br /> 1 'I IIMvn' ❑ E.u.no L3 L C Nu� si r
<br /> olhrr ❑ n:•:�krs....❑ a?rd L•nn iu,._!n. – ____ _. _.._______.. __
<br /> 1-) CASING INS I-Al.l.l.I) ( IXI II 10OHNI(ONS _
<br /> '..I Nrvl ln.slm ❑ \' IR.ef,. ❑ T'rlx fl.d a;1 „r --
<br /> Prnln 0 D, Gage Or Pmrn 'I'll ._—
<br /> (!.
<br /> Wro xnfao-un.mry r+I pn.dA..l° Y.., 4 N.. ❑ II
<br /> wr,�av,l,vanlar,.n•I Lahr1....' r.,❑ w. 5d
<br /> MnM.lofa.a4r.q— 'ERngde: F, Yi F'F9'13Cf11^ o',rzl Nurn.l r C.nnple6, lh�
<br /> (10) WATI-Al LhVE1,S -- Wlf I,1, 1) 1111,1! Is SG\'11•MENT
<br /> ILMHnf llm Waa•r,II F.u.n_ —ll
<br /> s Itt", rlf J.n.. r/I I,- un f1. o.r Pu6,dv lion nsrl M. rrporl iJ Inm ro rhe
<br /> � tiamllnpHxlaltrr..rll cmnplre.�n FG 4 /rvsr nJ ruy l,m a /!'r nnJ l.1l.rf -
<br /> n1) wF:LL Tlsrs: ,IEnr.. r/ -,Ittn
<br /> w'es urn11n1rmJr Yn ❑ N.. f_lX Ilrve.l ..L.. : ,,If
<br /> l'vp.rAtw rrrmn ❑ IWt., ❑ .ul lin NA\I
<br /> IMgLr wmrr.r..rarl of t,N ft. N(11.11.1r^I -- [,
<br /> ry vnY m .q n .mi. Ilwior p.ul^U
<br /> DlrlrurE•—R:•unar J—r, \v,1.,1.............. �II \d.o-,.•,_ 7itS7..T'rv, 1.1vaLlrik r..1
<br /> CLrmi.vlaul„1.rva.' Yn ❑ N'.. ❑ ❑p.•.L...!...v• _�C.P —
<br /> ,I wurH.lnrH.a r.n.l, Y.•• ❑ N.. I.7 _II,.+.nm.H..q..r.lLrsr..l.vr _ Lir,..:u \r. nM SA's 1..oLR
<br /> f 11 n' I
<br /> FORW AS
<br /> IF ADDITION AI IY
<br /> SPACE 10 NEEDED, USE NEXT CONSECUTIVELY NUMBEED FOgM
<br /> OWrr ,6!IRL V. ,3�.G1 4 `W)AS
<br />
|