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QUADRUPLICATE STATE OF CALIFORNIA Do not rill in
<br /> Useto ccn:ply with THE RESOURCES AGL'NC'Y NO, X29420
<br /> local requirements DEPARTMENT OF WATER RESOURCES
<br /> 159528 NVATER NVELL DRILLERS REPORT State Well No—
<br /> Notier of Intent Xn.
<br /> ,Ja+J Other Well No.
<br /> I,r,cnl I'r m,it Nn,nr Date ---
<br /> Claude 1�iCkQnaa (12) WELL LOG: Tnrd ae,,tfi312 rt. ne„m nr e.,n,pletrd wr11322 ft.
<br /> (p) O�i'1I�R:��nrn .r mate rinl>
<br /> 1 (nm, ft. to ! n 1)racf nr c�4ar, char of
<br /> Addrexs_.-City—— �Q. • .fes "J2-
<br /> Zin
<br /> (2) LO ,6r( uMI.L (Sec instructions): _
<br /> 60 1,2:ay
<br /> Cormty ```�'�� Oa•na•rs\\'ell Xunnrr
<br /> , AA
<br /> 68 Sand
<br /> Well addres,Ndilsn•nt fnno nfina•e --. '----------C
<br /> -3- 68 84 GlftY
<br /> T.n,n,hip 1��{�{•�{ ' �Jllylmi�,c�r�' Sti.,n__ _
<br /> Di,tanyy SC'V�i�bs""rn•`rV"""•�aY•�~ _ -.
<br /> w7 Tr
<br /> �7iR
<br /> + iiK�d
<br /> ItU a a'sur
<br /> g (3) TYPE OF WORK:
<br /> Vr,e \\'cll x Urrux•ninK 10, '- +l! CI riff
<br /> �1 -.-.' Ita•r.�nstrnrtion ❑ _ IfA
<br /> L ; HrcnnditiuninC 13 - •224 Tjjw* `Wd ttl A _1 BY
<br /> •, r_. -
<br /> l - -
<br /> I.,rirnntul Well ❑ Har .rte=u awi7 A�
<br /> 1 �,I
<br /> Ue,tn,rtinn ❑ IUr,c ml I �L
<br /> dr,tnutiun n,:Uerinl, rtrl _
<br /> .�`I � - �_ pn,arahrn•s In It 1.)
<br /> (4) PROPOSED USE: Clay a1tiiid_ ,.sl
<br /> n„n,r,ue
<br /> 8 2 2 ppi” earu�
<br /> �= lrrie•:tion p.
<br /> ❑ 2 - 8 Bl'OM C1a9,3t
<br /> Black Sand
<br /> t � _
<br /> St-k ❑
<br /> `a
<br /> ,
<br /> t � Slunu;pnl ❑
<br /> \VELI• LOCATION SKFTCII .- ,(hhrr C1roper we CUY 131- W” Ad on
<br /> (3) EQUIPMENT: (!i) GRAVEL PACK: - a3)n n� resgorw a
<br /> Heeenr ❑ _ :,•� ❑
<br /> No USira•''--- g r r@IIO'Y ng 0 e
<br /> I C:d,lr L Air ❑•' IT�ietrr•,F burr-- -
<br /> Other ❑ Ilucket Ynckid frrnn-----to--------jt•
<br /> (71 GING INSTALL
<br /> 1,\..:•.` 1 41 PERFORATIONS: -
<br /> Steel ❑ Pln,tir❑ C.m"etd�, '1')Ix•or perfbr:ath,n
<br /> it .. . To slot
<br /> From To Dia. Gauc or From, ft. Size - —_
<br /> f. ft:C� 'in. —
<br /> I (g) WELL SEAL:
<br /> ,da•d1 1"rs ❑ N,,X
<br /> nr _".
<br /> Wa,sfaor,nar
<br /> nitv 1"I Pn,a• - ,
<br /> \1'e n• ,tn.tn ,e.ala.l :rcain,t p•dluti.m'.' Ye, ❑ ... \l'nrk ,tnrtarl_-_— 1- _ Gnnplrtr•l
<br /> Uctlu Kl ..f ,calm• _---.---_-----'—'__
<br /> WELL DRILLER'S s-rNTEMENT: nu�rt nrr• rr. the Ent n) rnp
<br /> i (10) WATER LEVELS: —_n 1),i, ...11 -,-, drilled roofer nq! truiadirtinn nnrl th6,
<br /> Depth nt fir,t water, if ln..ari -- It Aru uledgr and hrlirf.
<br /> Spmdinc lrrrl :Jt•;r well e..,nplctn•n_.---------'_-'__-- - -
<br /> S Ia N F.II___---
<br /> (11) R•ELL PESTS: N. Pan( Wt)ll"T r�i Yings Inc.
<br /> 1'nnq, '� Hailer ❑ An hit[} \:\M1:-------- ,r tell
<br /> ,•,:,A...l '�i �'0„n�,in :'r`b�Yr.,`'I'���r' 'tS�IP
<br /> nas iter nt ,Inns( test—_--It. At .•t tr,t
<br /> a•nJ --__It .,,.
<br /> Ad-lrrs_ 61
<br /> .cul!mir, rdtrr h.,ur, a\'alrr I rmD•'ranur:�+7 �, ie� 1✓�•11i. - y _ --
<br /> 1)i,ah.rrrr_ -T, 14 fiitS'.
<br /> Chrroi.,,1 ae:dr.i, nndr? Y••• '- N” ❑ If ) '• I,y w :,_ •� �l 13cr4,.rl ..._Date of oris rrtrnl_
<br /> I....
<br /> N'a.•...r.Ina n, r,
<br /> 1'r,O N„' II .an,u h- b.Ih..r.'t••..r'' -._ -
<br /> ( DWR tae ..ncv --'va, IF ADDITIONAL SPACE�I{ NEEDED. USE NEXT CO CUTIVELY NUMBERED FORM
<br /> dui
<br />
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