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state of CaliforniaaL/`/v <br /> Department of Water Resources <br /> Central District <br /> 3281 S Street <br /> Sacramento,CA tselaaoV <br /> OWNER'S REQUEST FOR WELL DRILLER'S REPORT (WELL-LOG) <br /> Please use the back of this page to sketch the location of your well. Adequate Information <br /> must be provided before a search for the well log can begin. Give distances and directions <br /> from cross streets, Show landmarks such as schools, post offices, historic sites, highways, <br /> county roads, main streets, etc. (Indicate North on the sketch). <br /> Location of wet! (City and County) <,6 <br /> Street Address <br /> Township_/ s Range�, Section 1/2, 1/4 or 1/4 1/4 Section <br /> (City or County Planning Department may be able to furnish this information) <br /> Aesessoes Parcel Number(on tax statement) ��7' d,fid ' O <br /> (11 possible, please attach it copy of the Assessor's Parcel Map.) <br /> Subdivision or Tract "' Lot No. Parcel <br /> Owner when well was drilled <br /> Other Previous Owners <br /> Well Drilling Contractor or Company Year Drilled- ? <br /> Depth of well (if known) Diameter& type of casing <br /> (This information Is necessary If you have more than one well.) <br /> Section 13752 of the California Water Code penlnit� release of water well drillers reports only <br /> upon the written request of the owner of the well. The owners certification must be completed. <br /> I certify that I am the Owner of the well Please send a copy of the water <br /> descri d above. well drillers report to: <br /> Slgnat " Name <br /> Name George to VeldeJr. Company <br /> 3301 Ladd Rd. <br /> Address Modesto,eA 05M Address <br /> City, State and Zlp Code City, State and Zip Code <br /> Telephone Number Telephone Number <br /> Ste <br />