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QUADRUPLICATE `' ,f <br /> _ STATE OF CALIFORNIA ' F1, Do not M in <br /> Us0 Of comply With THE AGENCY <br /> ,l19local requiromemts DEPARTMENT OF WATER RESOURCEA1t .. <br /> 181 No. 226866 <br /> Notice of Intent No.- WATER WELL DRILLERS REPORT <br /> Iwrcal Permit No.ur Uate•_�c�Q� ►-I _A L f H Fj0!her We,t-�•r. <br /> (1) OWNER: NaoaeFta_aond Greer (12) WELL LOG: Total depth-2-15.Depth of completed w•el 21 . <br /> Addmsa <br /> 1563 Steinegul RAJ• from m <br /> ft. to ft. Formation (Describe by color, character. 07* or material) <br /> _ _ <br /> City— V sca lon. Ca._,i,, 0 2 Topsoll <br /> (2) LOCATION T OF WELL. (Ste in.;truc•tiow): 2 - <br /> Hardpan <br /> C•rrrnty- <br /> ",an J clAquin _Ovnrr'a Well Nombre_ - 10 clay <br /> � <br /> Weil address If different frml above 10 - 20 J!°1 <br /> nd <br /> 20 _ 60 Claw, <br /> ' <br /> Distance from cities,mads,railroads,fences,etc.�SL�e�. ltd�� - an <br /> I2:niles north of 1 120 a st side 0 lay <br /> - — and — <br /> 108 - 124 Clay <br /> _ <br /> (3) TYPE OF WORK: 124 - 126 travel <br /> t New Weil I Deepening❑ 12 - 135 Clay <br /> i Recrmstmction 13 1 140 Sand <br /> i <br /> Reconditioning [] - 160 shale & C $ <br /> i Ilodrontal Well rJ = ae sa ave <br /> D-trretian ❑ (Describe J 0 C $Y <br /> destnrction roaterfats and <br /> pnrcedarrs in Item 12) - 200 luacicsand <br /> e• (4) PROPOSED USEt 200 - 215 G287. <br /> Domestic - <br /> i <br /> Irrigation ❑ - <br /> i <br /> I' Industrial ❑ - <br /> Trtt Well ❑ - <br /> I <br /> i 3lxk ❑ - <br /> - Municipal ❑ - - <br /> WELL LOCATION SKETCH ._,I Other- <br /> - <br /> i (S) EQUIPMENT: (R) GRAVEL PACK: iOc7 ng - _ <br /> Ilms'y [g Revere ❑ Yes Ex No❑ Sire grnvpl - <br /> Cable ❑ Air ❑ Diameter of h.or_.^1 1 n <br /> i <br /> Other ❑ Roekct ❑ Parkes] <br /> (7) CASING INSTALLED:. (R) PERFORATIONS: <br /> Steel❑ Plastic Concrete❑, Type of perforation or sire of screen - <br /> Front To. Dia. Cite or From TO Slot <br /> ft. ft. 'in. Wall ft. ft. S!ze - <br /> 0 60 1 1q5 1 <br /> i - <br /> (9) WELL SEAL: - <br /> '*Vas surface sanitary seal provided? Yes IX No ❑ If yes,to depth_ <br /> Were strata sealed against Iwlhrtion? Yes❑ No INemal _ft. <br /> w \Iclhod of -ling— F'entnni tg Work st.—L- _IH Cvmpirt eel _19 <br /> (10) WATER LEVELS: NFELL DRILLER'S S'[ATEMENT: <br /> Depth of first water, if know - - --- ft. This uetl —drilted under env i-Wictian and this moi is trot m the best o1 my <br /> ftkwrcledYr and heloel. <br /> Standing level after well t—pletin . <br /> (11) WELL TESTS: SICNho — 1 <br /> (Well Driller) <br /> Was —11 test madr? Yes ❑ No a If 1". by <br /> Type of tr.t Pororr ❑ Railer❑ Air lift 0N:1J1E t`''rnIng!" !3j'OS. Liril�ir Co.,J 1re1_. <br /> Dep h to ,cater at start of test ft. At ­1 of lest _ft (person.fico or copooation) (Typed cr d nted) <br /> Disrlrnrgr gal�min x)ter_ hours <br /> Water temps•rxhue <br /> Address_ r �•'inn•i l n i�E• <br /> Chemical analysis madr? 1'es ❑ No`X If yes. by wh,.m?__.__ Crh' s r; tsDate of this report <br /> � ^ ^ <br /> W.,rlectric log made? Yes ❑ No Z If>rs,attach(-fry h.0- report License Nn. _ `Lam_ ,1j _ <br /> DWR 1e8 trcv.'r•ve, IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br /> i <br />