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.t_. r.. ... I. ..) .. ..... .. -. . .. ')1:,�� .. �;M"a.ti'..vSw..;. ..t.a�..T � ...•t.is.r. ,fit i <br /> �3 <br /> ' J Y <br /> Y . <br /> STATE OF CALIFORNIA -frt <br /> QUADRUPLICATE THE RESOURCES ACr':cY Do not fill in <br /> Use to comply with DEPARTMENT OF WATER tESOURCES �- <br /> local requirements WATER WELL DRILLERS REPORT N0. <br /> 252927 <br /> r. <br /> Notice of Intent No. Slate Well No. �4 <br /> ...Local Permit Na or Dale $8—�QQ Other Wcll Na pli <br /> (I) OWNER: Name (12) WELL LOC: Total depth��f1.Completed depth��ft. <br /> Address from ft. to fL Formation(Describe by color,character,size or material) <br /> .1 at - Ttrary CA ZIP _ <br /> �(2) LOCATION OF WELL(See instructions): 4 — 5 Arii YAe Ia% <br /> .County Owner's Well Num 5 — 19 Clay �- :,' <br /> Well addres.Ir dlEferent from above :Tks — <br /> Township_— Range Section 211 — 30 Clawate' <br /> .Diosrep from dales,roads,railroads,fences,etc g riAw <br /> \ v <br /> Koun ' _ <br /> Y n+ <br /> 13) TYPE. OF WORK: <br /> New Well Q(Deepening ❑ A9 — <br /> Reconstruction ❑ 0A <br /> Reconditioning ❑ "? <br /> Horizontal Well ❑ — <br /> Destruction ❑ (Describe <br /> :., destruction materials and pro- 4L <br /> 4.. <br /> cedures in Item 12) V r <br /> (4) PROPOSED US _ < < <br /> Domestic _ <br /> Irriertion <br /> _ Industrial ❑ _�, y <br /> Test Well O ❑ rat <br /> '. <br /> Muriel ❑ _ <br /> - ale� •y. <br /> _ WELL LOCATION SKETCH be)\v\ _ <br /> a(S)EQUIPMENT: CRA I. CK: <br /> RMary f Reverx ❑ No SI <br /> Cable ❑ Air ❑ met of bore240 Clay <br /> s' K <br /> Other ❑ Buck a td from h <br /> s(7)CASING INSTALLED: (8) PEVORATIONB — <br /> �NI <br /> Slee) ❑ Pla QA e ❑ Ty Ion or sire of _ 260 Clay <br /> j From o D' Gage or <br /> ft Wall size — <br /> 41 Ft 0 <br /> ;�, <br /> (9) WELL SEAL:. �-y <br /> Was surA <br /> face sanitary sea)provided? Yea No❑ If yes,to depth fL — - - - <br /> �Werestiata Sealed against pollution? Yes❑ No❑ Interval fL — •- .;� <br /> lsfd1W.1seding BVITGNITE Work.started 19-$Jg Completed 19— <br /> <;..(10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> � <br /> ;-Depth of first water,if kmm fL <br /> This well was drilled under m jurisdiction and this report is true to the ; <br /> Standing level after well completion R7 ft- hest of mu knowledge and belie <br /> (11) <br /> WELL TESTS: Signed_ l 1 i <br /> Was well test made? Yes❑ No If yes,by whom? (We Driller) t-� <br /> .Type of test Pump❑ Bailer ❑ Airlift ❑ NAME • <br /> Depth 10 water at start of test ft At end of test R a' R nt . •�3 <br /> Address 35526 FIF NC <br /> Dlsclarge gal/min after hours Water temperature —vs�t� I1� ��—�hZ = <br /> Chamicalanalysisnude? Yes ❑ No`1 If yes,by whom? City 1109 STO, PA ___ZIP 95.35 <br /> Was electric lox made Yes ❑ No(� lfyetattachcopytothlsreport License No •+ r+T�'t_ halenfthisrepnrt M�fj�a�r1988 !+ <br /> IF DITIONAL.SPACE IS NEEDED. USE NE)(T CONSECUTIVELY NVMBEROD FORM <br /> Own tae(REV. I"at . as 96333 -. . <br />