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Use to comply with 'moi STATE of CAUronmiA n1011IF Do not fill it, <br /> focal requirements THE RESOURCES AGENCY No. 46922. <br /> i <br /> DEPARTMENT OF WATER RESOURCES <br /> N•nke,d Immf N,.. NATER WELL DRILLERS REPORT sof•u'ru Nn - <br /> Lc.l 14mnf No,nr Um.• ;Z;Zg30j (Mer WOR Yn. — <br /> (1) OWNER: N♦nx• (12) WELL LOC: Txlxl drfA. _n.D.RIh of c,a,pW d <br /> Addlnr1��11t�T�ie'I-h'.-LeRay <br /> It. Fmm,n(Inn (De.rnne nr mk.r. rMr.rkr. tkr m.krl.11 <br /> City Ripen, z+n <br /> (2) LOCATION OF WELL (Sn'Insmntinns): _ _�. <br /> Gump Can.--aFvaqqn —Touj Oumrl.\Cell Nxmhr. <br /> -tu..a � n <br /> l ,C•II.dJrn.it dlllemm tome74 <br /> nM•e _ _ __ <br /> II Tmn.hin-- Ibnve mu„n_ <br /> Okf.mv Imm dtln,n.d..mllnmd..Iran•ae..�.p., • It _ <br /> 9 and <br /> South of ♦ ,. <br /> r Bali <br /> (3) TYPE OF tvORK. (s- r�a�• - - <br /> Nr.r W.11 y-I 1"—i-¢ D <br /> 13 <br /> Ib.dumbl WO ❑ - 1)) <br /> O tn¢Wm ❑ Ilharihr <br /> dw ,exn mdd. w <br /> In°lien L°\ _ ^• - ) \ -" . <br /> (4) PROPOSED'Usil <br /> nn <br /> Writ 0 <br /> wEIA. LOCATION SKETCH \\/; Ode, D <br /> ( ) MVELPAOK., <br /> I3; <br /> EQUIPMENT' a) C <br /> R,v.a. ❑ xr..r.r ❑ ,4n2J N;. St.- $ a �.\-•. :�nsg esx. <br /> ♦ - <br /> Cahk Al, ❑ \ iN.,.retrr,d lw,.r - <br /> 11. km D 'Pi kn`I.Inn, <br /> Ihhrr ❑ _ <br /> 1:1 CAti1NG INSTALLEDe�\ IRI PERFORATIONSiy�_' �.• <br /> S.n,t❑ Plnlir❑ Lnm mtn❑ TI I�,J perh.aNm naq.Ypmw utr .. <br /> Fmnl To. Dia. CII k2-nr Fmm size <br /> ft. ft(- ' in. N'nll ft. ft .. .... <br /> l <br /> (e) \YELL SEAL. - <br /> _ I U1r.oda.unien .r.l nn vidrd• ,r. 'l ♦ u ... .,Jrnlb �/_t-- <br /> \Crm ant. x ..I \1n4 •umrl <br /> __ --dnl .cam•t Ix lhnx•n/�m I ♦ Imrn.J._lV— . �� ly 1',m,nla I <br /> 19— <br /> ItI <br /> 1ful1rn1Wd1..fR,•A1 T.rEalRln[LEVELS: <br /> ^ °—• .��i II \nCdE,LxL. UxR '"fATE>I In fn: <br /> x <br /> and n , , <br /> . ... <br /> o den. I. ry+l xl <br /> r 1 .,w,I / — _ <br /> M 1' e k rI (. II. mht.•x. -�f—� \x 1 - )'1..—'^ <br /> 1111 \\FI L IE,f�: <br /> ten I nx,m, <br /> „,..1Ir.. x Henni�r►g'sn roerrn�r�.lL'S'2ss <br /> - <br /> I Int —J ,,,c,..._3525 Pe181ICS2e kVffi <br /> . ......, „ u.. - <br /> la+home. - L'1 " '^—�O(iCStrO -CA- <br /> ...... <br /> u ,., ,.1 <br /> clx,,,x.l xn 1 1 + .r LnnT.. ppQ <br /> N�.M_�nr 4 1 1 \_a I. •.. .er..i ./�t W- C UTIVELY N <br /> ( Lwn IeB •rr •,*e IF ADDITIONAL SP4CJ NEEDED. US EM1IEXT'_O�$F�CUTtVELY NU MBERE.• FORM .L <br /> lana:. .• <br /> — _� v <br />