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<br /> '';}`r' a Y��.+`�.•� '�.+ ..., j .. v '. ..��� -.. �,_• �( K•..-r r� •,�}:+r.. .i`l4+��.i t Y,'n,'•'�`��' �}� .
<br /> L `.', ' (• ` ^ , 1;�, /`�' 71—SiDo Not Pllllx
<br /> STATE OF CALflONNIA
<br /> I t V? rG�-('� THE RESOURCES AGENCY
<br /> DEPARTMENT OF WATER RESOURCES e
<br /> Elis with DWfi
<br /> ' -WATER 'WELL DRILLERS REPORT state Well No
<br /> 1 ; Other Well vo t^
<br /> t (1) OWNER: (1 1) WELL LOG: '
<br /> Name
<br /> Tool der,h h D<r,h (<completed dl
<br /> t# Address f ormationt Onn)Fr b>•rota,rMrrrfrr,sin o/wNriJ,u/rhar/vr- _ Jy}'t c
<br /> (2) LOCATION OF WELL:
<br /> �,���!5; •1 l:ountr _ O,rtr:r's numM•.i(an• �� V
<br /> T--hip,RmRr.tmd Sec,ion :7—9,6 r
<br /> Diumr<from civa,ro,da,nilro,d,.<K.
<br /> Y
<br /> (3) TYPE OF WORK (check): _ �r
<br /> • `e
<br /> f
<br /> New Well V Deepening ❑ Reconditioning ❑ Destroying ❑ •�
<br /> tc
<br /> If deslrrrlion,drirribe meterid and procedure in llrm 11.
<br /> (4) PROPOSED USE (check): (S) EQUIPMENT:
<br /> Domestic (Industrial ❑ Municipal E3 Rotary ❑
<br /> Irrigation ❑ Test Weli ❑ Other❑ Cable $7— r'
<br /> �a Other ❑ ". I
<br /> (6) CASING INSTALLED: r
<br /> y*}„t sTEE oTNtrr: If gravel packed >'
<br /> SINGLE DOUBLE 1]
<br /> r c.
<br /> �• i•t�
<br /> Gage Diameter
<br /> From I 'I'o or of From 'ro
<br /> �,s•J ft. ft. Diam. Wall Bore ft. ft.
<br /> .rte rite■:
<br /> ,.;
<br /> '� DrK ribe W.:t
<br /> .Ypt; (7) PERFORATIONS OR SCREEN:
<br /> ��`,`'�-�" r�•IM Or itrfYr.,i.,n ur nam<Cr K,<fn . ;J`; ,
<br /> r.�•f, .- Perf. Rows
<br /> From To per per Sizc `
<br /> ' _ ft, ft. row ft. in.x in.
<br /> «q
<br /> (8) CONSTRUCTION:
<br /> �1c,,�cc W.. „rLc ul prn.,dedi Y<,Cl No❑ T. his J,1— rt.
<br /> ,�
<br /> Y',❑ No r
<br /> -it1
<br /> 7 Fr..m !c.to ft. tY•nr1 nnteJ - la 7.�L.Compl<ma 51—/ ff 7-�
<br /> WELL DRILLER'S STATEMENT:
<br /> ',''; �n,•t Tbit well was drilled tender my jurisdiction and tbit report is trite to the best
<br /> t-:_:• rj (9) WATER LEVELS: of myknowledge and belief.
<br /> t A' � Urvsh at vhi<h v,:rr „fires fnunJ,if Lnovn it• -
<br /> nY
<br /> i + NAM[: s'
<br /> ErlY(: SunJir[ Irnl bdorr rmm�nn<. if km.n
<br /> it (I'non.firm.or corvonnon) (Typr1 or pr t,d)
<br /> i ~•.: 'i )unJin[ :curl after nrrf=,raunr anJ...rlorin< ft.
<br /> �"T•-''• Address / I�<C�IS ST'
<br /> WELL TESTS:
<br /> r<s.Lr.h%
<br /> .�,`r� •--- ft.Jravdn.n alar her. ISIGYrDI
<br /> r°' Urrl)
<br /> wa a eh—iul a 1a i,made? Yn I] N._
<br /> -_-- �� �_
<br /> .. /�yy
<br /> �* w"+•_..,tic l0[1,.dr f�dlr Yr, i] a,Na I(vr.,, .<h rite. l.iccns[ \o. Datcd� 19-1
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> D"R 18,3 r6.. aa,)a-raJ a•Ya aOY Tnie AD Oat
<br /> I-
<br />
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