Laserfiche WebLink
ORIGINAL "rAri CIFCAUrORMA <br /> ' Tiii3"SOURCES AGENCY <br /> File Wi1eF1 DlAIR DEPARTMENTDo <br /> OF WATER RESOURCES not I1I✓< {tl.-.. ' <br /> WATER WELL DRILLERS REPORT NO. 1 <br /> 'ice of rntent Na ��2 9 7 O I <br /> al Permit Na or Wte State Well Na <br /> (1) OWNER: Name Other Well No,G <br /> i Address (12) WELL LOG: Total depth aQ,d ft.Completed dept <br /> >,15&—ft <br /> City ZIP From Ft. to Ft- Formation(Describe by color,character; m <br /> size or material) <br /> al)LOCATION OF WELL (See instructions), <br /> Count ) <br /> Y Owners Well Number <br /> Well address IF different from above _ <br /> Township R911 'Z=nA <br /> a O _ <br /> n e <br /> g --��.Section <br /> !)"stance From cities, roads.railraadrti fences,etc.. <br /> i <br /> (3) TYPE OF WORK: r7 r i 5 <br /> New Well IXl Deeming-0} <br /> Reconstruction ❑ — <br /> Reconditioning 0 <br /> Horizontal Well Q — <br /> ll)eslruction EJ (Describe — <br /> dcstruction materials and pro- <br /> cedures in ltam 12) <br />` (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial Q \` <br /> Test Well 0 77 <br /> ' r <br /> Munroi <br /> W$LL LOCATION SKETCH ibe) Ll <br /> (5) EQUIPMENT! p f <br /> R sJt lT ~ <br /> GRAY CX: <br /> Rotary X! Reverse Q \ i <br /> Ne <br /> I p'I .. —1 <br /> Cable ❑ Air <br /> ❑ Fhore tt <br /> Other ❑ Burke rare <br /> 0)CASING INSTALLED (Bi FERi9I1A7I r., ` •` <br /> Steel ❑ Fissile — <br /> TyMpf i s'ze <br /> From T Gx a or — <br /> ft. f i Moll t <br /> size <br /> Ir — <br /> (9) WELL SEAL- <br /> Was <br /> EAL: yy,, V — <br /> WassurraceunitarysealpravidW? Yes Ai MCC] Iryes,todepth. t n7 ft ` <br /> Were slrali,sealed agaiart ? Yes l3 No <br /> ❑ I nterval <br /> hfethod of seal ` <br /> Work started water, Is t^,nm etetl l <br /> (f0) WATER LEVELS WELL, DRILLER'S STATEMENT: ts.� <br /> OepthaFfinl ter,IF known <br /> rt. This Reif:not,drifted under nr <br /> St.adlaKlevelalterwellcaaplettoa rt Ju isdkflon and this report is trua to the <br /> ft best of Itis knawfed and fief. <br /> (11) WELL TESTS <br /> Was well test made? Yes ❑ No 1F Signed <br /> TypeoFtest p ❑ ymb whom. W <br /> p Bailer { <br /> htow Airlift Q <br /> 4t otter at Mart of tat it. <br /> NAME <br /> Al end of test Ft (Parsee tiros ar mrporotlan) T <br /> xharge PI/min after hours Water tem (Typed Or pri ) <br /> Chemical analysis made? Yes perature Address <br /> JP No 0 If yes,by whom? City <br /> Wmelectrie made Yw❑ No If anacA to ZIP <br /> this <br /> -� LlcertseNa �. <br /> t]WR raatstsv. tAaey i/ A~TtONAL SPACE 13 NlL+DRD. UOE NEAT CONSECUTlInLY NUM>SEgED t<ORM oElhisre rt 88 ` <br /> to tatJss 1 <br /> 5�0- d 010' 0N 8<-;: bI On, 71 NrIH nna)—)77: (TT I ')TV14ZTfi <br />