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%10 '-or <br /> Cu:,tc•:,cr obtained permit <br /> (AUdDRUPLICATE STATE Of CALI PORN I A DO not fill in <br /> Use o}comply with THE RESOURCES AGENCY No. 187148 <br /> tocol requirements DEPARTMENT OF WATER RESOURCES <br /> c.al.e.a,xtent�.. NATER WELL DRILLERS REPORT stat. <br /> Odnr a'.n Nn. <br /> ,...,1•r.rrrx gin.x D.x <br /> OWNER: s:.me 7:nnrTant O :•iBteTy}rtae'*r; (12) WELL LOG: T..t,d.ntlr_j-f2SLlt.Depth rd nvRtOkxd rdl yV V n. <br /> 2120 W41COX Road mm: 11 n, k. Fxnnonm f r "h. hr mon. <br /> Add! 95205 0 - 5 Sand <br /> c:n• JtO�kLon. CA1S1'. rtr _ C <br /> lnv <br /> (2) LprATIpN OF WELT. Is,in>Irno,i.m): ) _ L. $ d _ <br /> 58n Joaduin rn.+,r:.\r.n nllmhe. <br /> C 72 clay <br /> aTen Ware+a a d;xercrx rmm.hm< 10§ll_S. SRlall Rd. - L 0anct. <br /> T.,w,MnFrench C2nlxln. Sx•1Y I <br /> nrmrn<rmm aa.,,.rRa.,mnn.m,rem<a. <br /> :ran <br /> (3) TYPE OF WORK: 1 :^ 0 uay <br /> Nry \\'ell x; Ikel+min[❑ <br /> Racxxtmrti•m ❑ - <br /> Reo.Mill.mloN ❑ - <br /> 11.'&.nt°I Well ❑ - <br /> ire.trxek,n ❑ ( serlhe - - <br /> '..,d.hm . Al11. 1.lyd <br /> (A) PROPOSED VSE" - <br /> o-xx.tk prix 'X. . - - <br /> IramNiul ❑ <br /> TOR U-01 ❑ <br /> SwvY D <br /> �• Munkll•nl' D - <br /> WELL LOCATIO\ SEETCII - lMher ❑ - - i <br /> ISI EQCIPAIE\T: (R) CM\TL PAM, - <br /> rknna Q Re.er.e ❑ Yw Q %..b N. <br /> a'r).k ❑ Ak ❑ DWnner xr M:n - <br /> IRMr ❑ ext« a Pgied/nxn 5(, -m.1�Lr_Je. - <br /> ITI CASIYG OCSTA'I IA) PERFORATIONS: - <br /> ' Sa<1❑ PIARi. Gmc1Ne'❑. Tsl<ur Oeanraxun.n,xe nr ween - <br /> Fsum Ta - Dia. CaLni or From Tn Slot - <br /> $. R C :in. \!'all It It. s!W - <br /> (U) WELL SEAL: G/ I <br /> aa'aa.x«r<un"ary rel pnn dedY Yn[jo[ \x ❑ If yr., n.&Nh_f.>✓.it. - <br /> \1'!R Nn.C Inl.n'a1 IL <br /> ht« d •A whn '1n tnnitn ___ ac...l <br /> (la) WATER LEVELS: \VF.LL. DRILLER'S STATEMENT: <br /> Dngh d tint riser, x F.w ._— IL <br /> Thi, ._II u. dnlfd xnyr xr4 ixrkdkfN.n .M M4 rcq.n 4 xxr m fhr Mn n/ qF <br /> >l.m,mu hd ahe.rA o xnvklk IL kn.nJ.d¢, and Mid. <br /> r 111 <br /> WELL TESTS: — <br /> Wa. .dl ht mad.' Te, r ;_ 11 rn, La rMnu (W.11 D"IW) <br /> TIP.a 1n1 Armp Ra1Yr❑ Air IIR❑ <br /> IAgaA t•. xarr at wn rd Int L. S\V E.____o 11•enrm.fim:..+ avm.utim)i1' <br /> rgd nr n_rnxTdn) e_ <br /> Al ml .a1-111 <br /> ta.xr dnpwrnn:o- Addr.,.__J(.1 - mil WAV <br /> 9580 � <br /> 12mrid .e.A+:. may% Y.. .- N•. C it <br /> h aye )' -) C. It. ..vnh u.L•'n.rM1�. rcry.n � Li..-u..]o.._rla��l'f__�__Dal.u1 Ihi,mP•n_ —10-80 <br /> owe sea u.V +oe. IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />