|
QUADRUPLICATE STATE OF C.4..IFORri: DU lin!ft!!In
<br /> Use of comply with THE RE-SOURCES AGENCY NO. 248099^ 094
<br /> 8
<br /> local requirements DEPARTMENT OF WATER RESOURCES "#V!J V
<br /> WATER N17ELL DRILLERS REPOR`1'.
<br /> L,,al!4•r.rit Nn.nr 17:,1c•___r_ -..-- .-.-- ---_
<br /> +' ..r� u1.'ir•^�� - )• t UV hnl. IrtJ urllO�f1. j
<br /> 1) 12 WELL LOG: f, � f1. lint mp
<br /> • ry-+' , fr. t.. ft. 1'..nn.rti"n ,1)a.rrilx• by n•:••r, c1+ar.0 u•r. n+atrriall
<br /> addn.cc/o �._f.a.t4i�l� .l.: a_-:i]:aT - .._ �r... i� ,.n - 0
<br /> V_..�_ {
<br /> (2) LOCATTQN OF vvELL t ticc in 1:uct;uru}; _ [;18Y
<br /> -a w",U_.i �1cdl �� - tee) firavel t
<br /> irrll:nW ra•<s it[lill error fnan at+uvr �_�__._�_ -• •• -._.7- _. 3� [,r y +7 P+
<br /> ._ I
<br /> T.wn.hip—l�'�i�—�-llm,cc_-.�; Sc•t:.m,-+_T—•—� - l
<br /> o. of , lati'.ay _ 37 Gruel --
<br /> [ 1)idanrc" ride..marls,n.ilr,.ntl. fen cc,etc- -
<br /> �a
<br /> Gla
<br /> cast sfc� - t 1 h1ack ward
<br /> lyla
<br /> {3} TYPE OF'NVORK. 114 113 ;kind
<br /> 118
<br /> s L
<br />! - \eH \I•e1F I•. f)c.'Peninc 0 1 7 8 �t-1.1 f 'LUtl ]
<br /> ❑ 1 i - IVA
<br /> - ,tt•.,,natr,rrti.n t 1 ..,, }� p
<br /> lln'und;tirminY t� f'' - 11 C �.,,.7 l�' vJa l�
<br /> - tl•,rirnntwl Well ❑ '" 1 irp�jM ff �t j
<br /> i V Ll 4 iJa f.�
<br />' i f)ntnMiau ❑ (Descril•c
<br /> ( tic,tro ure,; a[tri,ls Attd - 0 SL -
<br /> i pnxcdum la [km 13) � --- I
<br /> f
<br /> {3} pROPos»>7 usE: ^Q - % M.kay.�.
<br /> 0
<br /> I nduatriat 10 22 - 2 Sand
<br /> -i Wll ❑ 2 - 2W Shale Clay i
<br /> 0 240
<br /> ❑ 31 �2 33 nu :. 4rave�
<br /> tr k;L1. [.00al'i0\ SS:k,TCIF Othc: ❑ 3 {� �S7_2_. O -•—
<br /> [S! EQGIP)IEV'Y': fE? GRAVEL PACE: i:OO AI1�j p a i
<br /> Rn'rnr (� res rS Nr•C site I
<br /> s! o I
<br /> Cahl•- lJ
<br /> Air Cr
<br /> Bucket ❑ 1':,rkrtl Poon_ _ ,
<br /> I (,I CASING INSTALLED: (91 PERFORATIONS:
<br /> t.
<br />! Cn:K:ete ,J Trp—,i 1+crfnr tion•,t sixr��f ec n•rn _ E
<br /> Stcd.�] Plastic[,' { _ s
<br /> TO Slot
<br /> a ; From Tn Dia. Gage OT From ft size - I
<br /> ft. ft. in. all ft. -
<br /> I -
<br /> -
<br /> (9) WELr. SEAL! it. -
<br /> �.. ❑ [! •'rc, to berth__ --
<br /> \Cts sn,facr s:mit:,q•sea:
<br /> W,re stratn eeASe,I g4ainse p.•lluti•-neo,. fires{] tiPnrk >lart �' 19 0—I'letrrl t�
<br /> !•[ethrx! r,1 xr Lns�.---- -t `y--��— r��
<br /> I 1l'ELL DRiLLE:R'S STATEMENT! j
<br /> (10) WATER LEVELS:
<br /> ft. fhit ur1l rear drilled under ney ira,;.dietfun and this n•purr i. ln,e I. the brat 14 nrp
<br /> Depth n1 first ++'Ater, if knaxLn_ C') _It. Rnn,rfedge :ard bclicl. l
<br /> iStanding lecel liter u-e11 cl,rlieti.'n__— S
<br /> WELL 'PESTS: Wellnrlu�u �}
<br /> \� IF •r.. Orn .•hini.� '
<br /> tL•ar well tele made? 1-es C C AiT lift L+ \:1?.s£ `--*•'r': T'ii} s. _
<br /> T>r•e of tot Pump G' 9aile, LJ
<br /> At end .>f te.e H fYera..r.,lion ,.r c,+gv.ratinn•� t1'YPr'ct r.r Printedp
<br /> I IkTth to xairr +l atnrt nF test ![. r7r i ••� T T.
<br /> 4...�r.
<br /> Add r•s r [��
<br /> 1 uun � mer Im'I'_iah+re -,..+.•-_r.+r , ziP-.L�
<br /> 1)ixhar9r -eal%min nitrr�—h C.ts,
<br /> I Canalysis made? Yes 0 1n U if-3:s, by "S:'t''' R e of this repo 3f�
<br /> hrmlcal
<br /> s \o C if re,.Attach aq.v t..11knpnrt -Licntsr Vuy .
<br /> itt'ns ctna.ir ls:mn�. -err�- —�-- -!
<br /> ! _ ..... AnDITIONAL SPACE IS NEET]ED. USF NEXT CONSECUTIVELY NUMBERED FORM
<br /> pWR 180 IAEV."t•7t. IF
<br /> l
<br /> I
<br />
|