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r <br /> ORIGINAR <br /> OTATC OF CALIFORNIA ' ' <br /> I File with DWlt THE RESOURCES AGENCY Do notliuj. <br /> r 1 <br /> DEPARTMENT Ofr WATER RESOURCES <br /> ."„t,�.*,rt Intent Yr,. No. 21485 .%.-. <br /> � <br /> WATER WELL DRILLERS REPORT �'� <br /> k -i Penni(Nn.w pets Srote Walt No ew <br />{ Other Well No <br /> (1) OWNER: NArne <br /> :trk[reis P. • <br /> P 0 Box 4 (12) WELL LOC: rrxar depct��rt. <br /> Dopth of cnntpMted w4IIJQQJ <br /> (:its. $C <br /> from R, to it >ormatina (Describe calm, character, aiu nr matertal) t <br /> 'LIP <br /> %,f t LOCA rONo OF n LL F See instnictions): <br /> e� Owner's Well Number .r c <br /> "'ell address it dilferom tram above Z2� 0 San <br /> T.•wnahlp not amiable <br /> Sectfn a <br /> Di,tdna,o(near i!'es,no;eds, railroads,fence..ete.�Jenny Steinmets :> <br /> Banta <br /> ____103-108 & clay <br /> 1 -110 , S <br /> AV(3) TYPE of rvoRK: <br /> New We1t.Q [7tepeginS ❑ <br /> Reentatructinn 1 _ <br /> Itecondit9minr ❑ _ <br /> k <br /> Hodumtai Fvelt [] _ <br /> Destruction ❑ (Describe <br /> proved t(on n te. 1 <br />' procedures ip It � - -� •�, <br /> Ik (4) PROPOSED% <br /> n <br /> Irrigation- "r LC <br /> Induatrial ` ❑ �' ' <br /> Test well \ r1 ❑ ,�:. \);y <br /> Municidaf. <br /> WELL LOCATION SKETCI[ \`� Other ,;�\ ❑ _ <br /> (3) BQUIF%IENT: (B) CRAVE)'.PACK: <br /> Rrtury lieverse ❑ ,Yts:m No Q <br /> CAhle Q Air ❑ �� rteter of More �•' _ <br /> Other \ trr 1Qt). w <br /> ❑ 8erekef Q <br /> f'1 CASING INSTALLED:'-... (81' ERFORATIONSrh <br /> • . _ and cit �:, :• - <br /> Steel p PJAMe Cogereia <br /> Q <br /> Type,of perfo;Won nr�txe of screen.':\ _ <br /> From TQ-- Dia. G'tl[`tlor Froin, :i To = S1f17��. <br /> Et. (��' in. Wall Ft :` �. ft. 'sizes M <br /> (9) WELL SEAL, <br /> Was surfete sanitary seat provided? YasM No ❑ If Yin,to depth-50—t. _ <br /> (fete strata sealed agalmt polluting? Yet❑ No t; IntenaL „ft <br /> Method of iealGt 3 <br /> Work start I9 Cnmlikted., 19�__ I <br /> ( <br /> DepthWATER LEVELS: WELL DRILLERS•STATEMENT- F <br /> Depth of fist water, if known__.__. <br /> Standing levet alter wey cemptetlo k' This (cell um driUed tamer mV iuriadictiotti and rhia rtyort G rare to the bear of mir <br /> kaowiedgr and btlirl. <br /> (11) WELL TESTS( Stcasn <br /> Was wetl test melde? Yts C) NO[$. It yes, by wtrorn? <br /> Type of rot Pump ❑ Bailer O Air lit (Well DritFrr) <br /> ❑ NAME—Hanni,n s <br /> f)pth nr water at start of testft. At end of test-jtTrin- <br /> (Ptrsoa, or co <br /> f);saharge____�gelJenin alter rporation) (Typed nr printed) <br /> -hers <br /> Witter tempetatura Address <br /> Chemtcat Analysis made? Yes C] No If yes, by whom? City Mode iO r —Zip <br /> y uric 11-9 made? Yes [) No 1f s•es,artach y to this report License No. 0 1 <br /> at*of tAi,repo <br /> Otr.•.. iBti (ttiv.7.741 W ADDITIONAL SPACE 18 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM ..•i..Ne r_rr carr owro A�rov I <br /> )F <br /> I <br /> 2'0' d OTO' ON ZS PT 00. 7.E NAH nno)-)77- nT I ')T\AInTn 11.1.r <br />