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e• <br /> I <br /> I <br /> QUORUKICATE STATE OF CALIF)nNIA DO not fill to <br /> Use of comply with THE RESOURCES AGENCY N�. 244623Iarnl-equiremerla DEPARTMENT OF WATER RESOU'.2CE5 <br /> Kod.•v of Intent Nu.-- <br /> _ _ WATER WELL DRILLERS P.IEPORT Stm�Writ <br /> Lnnl 1'en nit NO.or D.do � �--- Oth-Well ^ <br /> (i) OWNER L.,i_LLiA J. Hanalton (7'3) WELL LOC: Total dep � <br /> tht Depll of completed well_ZQ5ft. <br /> 19563 �� -- -9 �g to i ft L, (t. mnan,m (j)—ribe by a,,. character. sivent material)_ <br /> Ad,lrcr,--_ 7osaaXif------- – _ — <br /> c,t) an --—'— – - -il'------- 4- 16 <br /> { (2) LOCATION OFWELL (See instrt.tioms). -- 16- 19 clay _ <br /> GNniy' C _.aIC1A�U 111 OwTx•r's\Nell Nmnbn•r_— —s= <br /> I \Nell.rutin•...it dtffercnt!mm ahnvr ------ 19- 2 sand _•� � <br /> - C av <br /> Lay <br /> Ad. Z7- 39 scrit <br /> Towmblp__,--_.. __.__Rang•.- Ser•c -- -�- <br /> Distance in citta,ro.b.mi!n,ads,fences,elc-- go 9 Ke <br /> — --m-7-74Z <br /> _ ` CLAY <br /> ---• <br /> £BCa_l4il�Telsl �• 63 Illand — _ <br /> 1 (3) TYPE OF WORK; - <br /> \.fa New Well A Das•Iening ❑ - - <br /> 90 <br /> �.� Recnmtnrctinn ❑ ` <br /> re <br /> ' Reconditioning ❑ - ^ <br /> \ - Horizontal Well ❑ <br /> Drstnmtiun ❑ /Describe _ <br /> destnwtion mahrrials u,d •-- <br /> '�. proedures In Item I- <br /> A\ (4) PR:)M/SED USE: 156 lulay <br /> P - <br /> I>.rmtstic � <br /> �it(. Indrutrial ❑ - I <br /> Test Wen ❑ - <br /> /'I f '�'•ir,/; •j /� Stock ❑ - <br /> :Cy `-`TT rluniclpal 0Tsi�A7f�T 1 laM/fit VA* j1R� a1 Iva <br /> Am <br /> WELL LOCATION SKETC11 Other ❑ i <br /> -.!S/ EQlitPMENC: (N) GRAVEL;PACK r f•O= any alt'atBt io -- <br /> '. Notary X Reve— Cl Yn.Q, No❑ <br /> ,','able <br /> C] Air ❑ Diameter of bore-- -- -- — <br /> other ❑ BwA& ❑ Packarb from-SIL_-tn--L1f.L-ft. _ - j <br /> •' .r. /7) CASING INSTALLED:•( ` (S) )'ERFO:MTIONS <br /> .Steel❑ I'lastic•[ Concrete❑'•y <br /> Type�t pe�orahrm ur Due of screen <br /> From To Jia. GTo Slot <br /> Wall <br /> of From ft• size - <br /> ft. rin. \S'nll fL'• <br /> (9) WELL SEAL, <br /> No❑ If y's, to deM.'s—.�V—(t. <br /> Was surface sanitary shat pinvtdtd7 Ye!•�] — i <br /> 111 <br /> We,• stm u sealed against pollu:ion? Yes❑ NO� Intrrval- ft• <br /> Mctlad Of sealir.y <br /> Z �— Work start 19_ Complet <br /> (10 i NATER LEVELS; WELL .DRILLER'S STATEMENT: I <br /> (10) of Fn. wTter, If Sz ft. This well was drilled under my furfsriirttnn end this "Port-S tore to the best of my <br /> _ft• konw6-dge and hefltl• .-.. <br /> 5tandin;; Vevel aNer well completion -- 1/"/; �- <br /> 111) WL_TESTS: SI <br /> •.vED � 0.�- - <br /> v whom?-- �(Weil Driller) <br /> Was . Bail <br /> 11 test mode? Yes C] NOJe Boiler Air Iitt ❑ <br /> Type of test PamP ❑ .4AMF_ 111 <br /> I)epth to water at start Of tat_ —ft• At end of 1"t ._ft Addres, �+ *%,a, on d Y P - <br /> + Discharge gal/min After-- \•Dun Wile, te••nlemtnr --� aClty_ a Calif <br /> Cht_j_I analysis mode? Yes ❑ No❑ If yes, by whnml <br /> s No .0 yes,ottsch copy u,tFls report Licerue Nr'. —_—_--�'ae u!this rcynrt-_. <br /> - Was electric L,g made? _Yes ❑ C-- _ <br /> USE NEXT CONSECUTIVELY NUMBERED FORM <br /> DWR teas (RFV.\-Teti IF ADDITIONAL SPACE 15 NEEDED. <br />