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ORIGINAL <br /> AL <br /> STATIC Or CALIFCANIA <br /> filo with DWit THE RESOURCES AQHNCY Do n <br /> DEPARTMENT OF WATER RESOURCES of�i A <br /> I Intent K.- WATER WELL DRILLERS No. 0 5 213 9 <br /> ,ferrmit Nn,or�ro .,z $ REPORT <br /> state Well Nn <br /> OWNE13; N � , POlI t]ther Well Nn. <br /> Aware„„ 08 iR1, Grantline Road ---�— (12) WEr,I, LM: Iutat ae <br /> Cal Pty---$�•)]eoth nI rnm let <br /> 0ty Trac f rn»n It. to It. Formation <br /> Y. <br /> 4- (1)escdbe by color, charncror, size or m <br />! (2) O Z!p 0 Sol aterial) <br /> Q _ . 5811 �r <br /> E Cooney _ �08Q �' ' fsee eratructtutu): 4 <br /> \►'el[addmt if ditfaren!Pruni q�yB fkvner's Welt Numbs <br /> f <br /> T"WnA,P 2 S A <br /> 14 Divine From Cities.reeds,tailnrads „�, Grantl ne Road 53. 7 .-�� ►S (� <br /> mite W. of 0 <br /> Banta <br /> �� <br /> r <br /> (3) TYPE OF WORK: <br /> if New well JW Deepening 0 <br /> E <br /> Rernmrrudtom ❑ T <br /> Reatrrditioning C3 _ r <br /> ` Ilodmnt.l Well ❑ _ <br /> D"Ouction ❑ (Describe <br /> destnrelurtr material - <br />' Procedures ire Item <br /> (4) PROPOSED ' { <br /> P'4 I h Q rrigstinn C ; \\ �t <br /> r rpmo <br /> r Welr o � <br /> Stoc (` <br /> Manec3y\ <br /> WELL LOCATION SKETCH \ <br /> f3) EQVII I+rI': Other ❑ �r� <br /> (8) CRAV L`PACK: <br /> Rotary 0 Reverse ❑ ` \- �) <br /> •� No Si:e ' <br /> Cable Q <br /> Air I] \ 8tar of bore lea•.• wf <br /> Other Q Bucket C7 1� r \ y - I <br /> (7) CASING INSTALLED.-r-,L I8) PBAPORATI <br /> Steel \ \ <br /> ❑ ?lactic Cor a Type of a Jnr a of scm •, - <br /> �r� - 1 <br /> From TO Diq. GarC F V <br /> ft. ft•1 ;a. <br /> au <br /> ft TO <br /> 0 _ 4 , ft. _ <br /> is t <br /> ------------------ <br /> (9) WELL SEAL- - <br /> SVas cudate sanitary seal vrovkW? Yea <br /> if ye., to depth—UL—ft. _ <br /> \Vere strata sealed egmlmst pollution? Yes[] Yn <br /> Method of sea IntenaL���t. ' <br /> (i0) WATER LEVELS, work its j x_193 g- <br /> Oeylh of lint water. if knmv <br /> WELL DRILLER'S S"TATE�IEN'1; com let le <br /> senrWlnq level after veli mmvktia luefi uos J r aly I dk u h <br /> (11) WELL TLSTS: t Rnom°m redga sad al. "�° the beet of my <br /> Was Well test mads? Yes ❑ Gln$) SIGY <br /> TYve of rest Pump C] It It Yes..by whwn?erAfr tsf well vel ) <br /> °.” lift ©. Panes Well Dri <br /> rJepth en water at stag of te,�_(t NAMEm 11 Inc. <br /> li+,.;h.rrge At end nt test„-1t <br /> -•—.8mirt attar 7; n'L. ° Cw'P:rrotfOn) (Typed or Printed) <br /> 1i'ater tempera Address-11-5- • <br /> al analysis made? Yes ❑ : r <br /> liras electric b:t made? Yes{] No ❑ If Yef' by wham? City 0e a <br /> C] ft.-es,attach C"W to this.sc iFr T License No 11 <br /> nwR eBa tett'.t.sat IF AbDITION a°f this repo <br /> E AL SPACE IS NE$DED. USE NEXT CONSECUTIVELY <br /> NUMBERED FARM <br />_ 60' d 0T0' UN gn: gT nn, 7T NAH nnOf_.177- nT _ r., ,.......,_ <br />