|
ORIGINAL 3rATE OF CALIIOFNIA `go" DOIIOI,fi!1N
<br /> File wlll}DWR �� THE R£SOUROES AGENCY
<br /> DEPARTMENT OF WATER RESOURCES No. 17688
<br /> N.,.1,..'IF In,en,No. NATER WELL DRILLERS REPORT
<br /> IAwal Pent N. m D.1.2 'J -�3� � (),he,W.II]a._-
<br /> (1) OWNER: Name k.P! K� T Z (12) WELL LOC: iar. ),r.n J'�' e. Dmm•,t=nn•vl<Iea Wdo Gln.
<br /> Addne,tC)-f Qn L /,3 .��+ ,:+r,e! k Im.a n, m h. Fnm,mmn 1 D..rnhe b. mon, cM1amc@r ,net.n.l)
<br /> Ziv _
<br /> (2) L CATION OF WELL ;Sec instnstiors I: --
<br /> C:mntY -I,ZJ_q town<r'a \Cell Number -
<br /> \Ctll addme it different FA:A oMve -
<br /> Tn.vn•na�n�K�ir3rK.nre —
<br /> Di.Imn Imm aNr+. m.m. atln,.d•, fen,.v,,em - \ -
<br /> (3) TYPE OF WORK: a
<br /> Nrw \\'ell neelxninv ❑
<br /> neannam•,mne in -
<br /> Homr,.Ial Well G
<br /> Dnmua„n G (b,c,rbe
<br /> aenm:eunn ... tenaal• !
<br /> v.:,rem,rm in quem `y - G n
<br /> (4) PROPOSED
<br /> Irri¢a[inn/\(\�\ - Ll1.L�LL�d�k�-•-- 1J
<br /> Indmtdnl \\\\ ❑ 7=� C>M1
<br /> p' \CELL LOCATION SKETCH Odd, ❑ - ��
<br /> (5) EOUIPVENT: lel GRAN e cl
<br /> �\.rvIS�PyACK: - - -
<br /> C.'Me a� Air ❑ m J(bam_ - - -'
<br /> ,,he, ❑ Bucket
<br /> I CASING INSTALLED' IA)c ERFORA . 5: —+
<br /> Slee; PWdr❑ C, • t TrPn ofn Ix ,1.cr 4e
<br /> From 'fir
<br /> Dig.,f' r F ^Toa_
<br /> ft. fl( 'In. Nal) ft.
<br /> _L —
<br /> (9) WELL SEAL: -
<br /> ma. •udec. +eulm,y+eel pmvldrd' Yr+X N,• = H - ra
<br /> IV,.< nm<. «fnl ndai,u, P.Inninn: y” ❑ ^, lmervN h.
<br /> >IeNvl J +e.4n \anrk +lined CnngJet_ •�__ILl
<br /> I in) WATER LEVELS: � I WELL DRILL:ER'S s,rATE\IEST:
<br /> Dm,d+ •d b:e ay.,er ,i knn+' - 1° Fl it v I 'i1IrJ node. ,n., .....dm.., i. d In,, rna< -rr,< m the bee, a1 m
<br /> Stundinr level w, .volt ,mnlrm,^ J„yt„^;_,_ro l .1- and I i
<br /> Illi
<br /> WELL TESTS:
<br /> \5'm
<br /> DDeIv+r:h•-.dehlle"
<br /> Bad"
<br /> �0
<br /> Ar ih_ Yx e
<br /> .
<br /> it. <nJ a 1 Pr k
<br /> n,mr•aU Durhn.er c:J,mm .dmr hnun 'w,um
<br /> ,b.*ndmmenb-LenndaeJe6 1e, _
<br /> Nn G II lhr r u
<br /> n
<br /> , li vn. angio ..m re.wn e
<br /> vWR Ise •.ry IF ADDITIONAL SPACE IS NEEDEO. USE NEXT CONSECUTIVELY NUMBERED FORM .+w.++u.rucv eueCDr e.e
<br />
|