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IIS <br /> t <br /> I <br /> STATE OF CAuroRMu - <br /> QUADRUPLICATE r 12 REsovRCl:e AGENCY Do nut fill in <br /> Use to comply with DEPARTMENT OF WATER RESOURCES <br /> local requirements WATER WELL DRILLERS REPORT No. 270831 <br /> Notice of Intent No. Stale Well Nu <br /> j Local Permit Na Or Dale Olhe:Well Na <br /> (1) OWNER: Name ftXltte :feint <br /> t (12) WELL. LOQ Total Depth 94S fl.Cnmplrted JeMh__It. <br /> Addre•• 24900 .SorPlea Rd <br /> Irom(1. to It, Fnmalinn(Dexcnla_I•r enlng eharuM,L size nr material) <br /> City ACelalDO 7.11' O - G any unit <br /> (2) LOCATION OF WELL(See instructions): L - n rrtraYen mrjd)e r1my <br /> •� C my San .o=dn Owner'.Well Numl e, - As h", rl ay_n End si 1 r3r hrn t•1 aye <br /> Well address if different from.lave - and r•Ivrr. �=mxel <br /> Township�Ih Hangc ]I: &etiun 1L— - a .ua�D�M1r•i <br /> Distame from ciliea,rads,r.ilrad&fences,etc. - <br /> WA 813liphtly aast of "ORO 35 rr ad -bout 1 5 <br /> si a ❑nder%,W. 12, - r a 1.rirrla. <br /> \� .tri• (7) T^PE OF WORK: 7L - I W3 1L <br /> I" New Well B Deepening ❑ = 1 gilt!r3( clay - <br /> ry Rt»mlradion ❑ 1 �d bridle Plan <br /> Hreandilinuiug ❑ <br /> Ilmiznnlal Well r] 11,Nk ygg>�ranrj��eravR7 <br /> DeslmeHon ❑ (De•cnla - 21 <br /> destruction materiah anJ pro- <br /> I cedures in Item 12) <br /> C J11 (4) PIiOPOSF.0 <br /> j w Dumalic _ -- <br /> Y" Irrigation <br /> f`1V Ill �A ❑ /. / <br /> 'fest"Well \\/\ ❑ _ <br /> fi <br /> Met \\ f.' <br /> WELL !J:ATION SKMC.11 <br /> (5)EQUIPMiuim <br /> Ratary ❑ Rrveoa ❑ (1 Na SI.. _ <br /> ` Cade {� Air ❑ mn of <br /> phm ❑ Purl • ed loan In__•� <br /> \ - - <br /> Ir (Y)CASING INWALLEa <br /> Steel ❑ PI•Rle CJ r ❑ Typr a('pr11R ianmata•l a,. _ -- <br /> From a DGag(•nrjtirrl - <br /> ft. Wall .(.`� !.(l�\`. ✓Size - <br /> rVqi'ZFZ�iS. i <br /> (9) WELL SEAL: --- _ -- <br /> las Wowdae unitarYwlymridrd:• - Lk Na❑ Il px ln.lgllh -5n 11. _ <br /> Wne u.rta aakd.Railw pllmilm> <br /> ye,I} No❑ hor'-1 I. _ <br /> SILlwofa•h.R-- WnrLnhoov1 III_ I 1A.-htl '••+ttr 17 IN— <br /> (IO) WATER LF.VEI.S: Wfl.l, DRILLF.R'S STA'I'I•:NIEN'r: <br /> Urph.l lia•.ee..it Som.. a li Va., arI1 ¢aa I(Ird under out pniolonon and this Trim! A fru,/n the <br /> A.ralrn' rflah....'11 roo"Iroon l}, II tars(of my kr VIAT and 1,.1 <br />