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f <br /> �TT.Te OF CAUaDRHIA Do not Jill in <br /> ORIGINAL THE RESOURCE! AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCESG <br /> A1C 2700nZ <br /> N <br /> WATER WELL DRILLERS REPORT L O <br /> State Well No. <br /> Notice of Intent NO Other Well Na <br /> Local Permit No.or Date <br /> (1) OWNER: Name (12) WELL LOC: Total depth--(.Completed depth_ ft. <br /> Address 7A9from ft Ip ft. Formation(Describe b Im'cholnrter.s1m nr matedel) <br /> City T d' Calif --ZIP - Ssall <br /> - —SdDLl --- <br /> (2) LOCATION OF WELL(See instructions _ C1- <br /> County S TnaD tin Owneri Well) �"^ rl—^ie 9 It �_�TNumber rl av - -- <br /> la{yTWell address if different from ab-11- - ilt-cg^ dy clay- <br /> Township <br /> ownship ZN Range 6F. Sed,00 C h� CnaraP ca <br /> Dislencx(rum cities.rinds,railroads.fences.eta _ <br /> ft NW •1 'va <br /> (9) TYPE OF WOR,: •3,5 - 14 h laC <br /> New Well 91 Deepening ❑ and <br /> `ler Reconstruction ❑ - <br /> ��tltl -s Reconditioning C <br /> A •IWnW' Horizontal Well ❑ <br /> - - , <br /> Destruction a (Describe n„ 'p( Ornrl�and_ <br /> destruction materials end pro- jja\•)/p, •�••e- <br /> endures In Item L°°-) <br /> Q`i[°\it f 1r (4) PROPOSED CS . <br /> ya a 4 Domestic - <br /> Irrigation O Industria] O ❑ <br /> ';est well ❑ <br /> (� niciAal\ ❑ <br /> lse) _fE <br /> WELL LOCATION SKETCH <br /> (5) EQVIPMFNT: CRAV <br /> Rwry ❑ Pewx ❑ No St. <br /> cable 7❑ At, ❑ net otbore _ <br /> BK1 ed ra <br /> Other ❑ -- <br /> p1 CASINCINSFALLED (S) PE TI \ O <br /> Steel $1 Plvoc ❑ TY at fG re of - <br /> U' . Gage Or 't <br /> f <br /> F t. t Wall <br /> It. <br /> 0 178 3 .156 <br /> (9) WELL SEAL: SO n. - <br /> rya Prnvi > No❑ I( n '-dePlh. - <br /> wasmdueurlmu I ded Tn .� Y IL <br /> Ilmien° Tn ❑ No F.1 imerval tQ4— <br /> wereRMtaKakdaEairnrpo Work star ed <br /> r + otos <br /> MCMdof +lint - '— WELL MILLER'S STATE?LENT: <br /> (10) WATER LEVELS: _1\ nr t a srae I+rhe. <br /> Deplhvf(in,wyel.d tin-n 7'1,. poll I at drilled v •r rm i'�'udianon and this report <br /> Surldum� :l silo.ell\mmpin.nn_— <br /> 641 Ir Irar of m9 An•w( dge turf IA•hr/ <br /> (l!) WELL TESTS: siKnnl \d sp 1 <br /> n> Yn ❑ Nn 3[ If Yn by"bond Th v r l s=1 1 Dr r1 1 'nO <br /> Wv�.ellld maJ Pum C Ruin ❑ Av lilt J VY�.,f. ai) <br /> Type aunt P _rr .p, n.hnn.I .. HrklmnR,C'rI� Pr <br /> 74II7 G. Li\_e Q <br /> D.pm m..ao-ry uan al lKl w,lero-m C)92,40 <br /> on.wrae_qo1/min ail:e__hm,n rr"'�•' oil.. Lodi Ca>_; ZIP_- -- <br /> Ch.mmalaoalrsnnl.de> Yn ❑ Na❑ E,^b•.1"""" 391542 DII,enhis'ep—t <br /> Yn ❑ Vo❑ Ifam anuh..q�+un hl,;77.- Lh nn>+Vu <br /> \4'y elKlnt ltR made M .aa>a <br /> IF ADDITIONAL SPACE IS NF.EOEO. USE NEXT CONSECUTIVELY NUMFIERED CORM <br /> PwR l.a IF". 13-Gel <br />