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l <br /> 1 i <br />{ ORIGINAL STATe OR CALIFORNIA Do not fill in <br /> File with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 077020 <br /> :..rf Iruent:h+- WATER WELL DRILLERS REPORT su,u wen No <br /> I. <br /> at Permit No.or Date Outer Well Nup�S 4s <br /> (1) OWNER: NIA <br /> (12) WELL LOG: Totoi dcpt�aft. Depth of completed Wei t. <br /> Adr)re from it. to k. furmn iUeacribe by eufar, character, size nr matadall <br /> City - i <br /> (_) L OF Un - <br /> Gumty - <br /> Weil addrea <br /> F TownahiD npn_- „ , �_Bectio <br /> ISistanco rem cities,nAw.% rallnwds,fences.He — <br /> le 0 <br /> — G <br /> (3) TYPE 0"ORKS <br /> New Well VF13tepirtting❑ <br /> Aed�rfsttvginn [j <br /> Recnrxlilivnhmg <br /> Horizontal Well ❑ <br /> Dctruction ❑ (Describe <br /> destruction materWs <br /> L fo�e / Ll n�. Procedures In teem <br /> NE1 � (4) PROPOSED _ \\ f <br /> DomesticIrrigationIndustria)Wen v ❑ v — <br /> i irfuatclps�7 -.--.\- <br /> WELL LOCATION SKETCH Other �' ❑ r� ' <br /> (SI EQVIPAI a (B) G PACK: <br /> Rotary Reverse ❑ No Size <br /> Cable ❑ Air of bore <br /> /l <br /> Other ❑ Bucket <br /> 1 i i CASING INSTALL <br /> Steel Pbuti: 3QType of pe o�h. — <br /> of scree — <br /> Frnen To Dia. r To <br /> ft. f in. all ft _ <br /> (9) WELL SEAL: +` - f <br /> Was surface sanitary seal provided? Yes Iii ry- 11 yea, to dept. - F <br /> Were strata staled aplalast ponutinu7 Yes Nn ❑ lntervat- ft - <br /> k <br /> tleelt xl of scalingW.rrlc starte 19 Compkt 14 <br /> l 10) WATER LEVELSt WELL DRILLS STATEMENT- <br /> J>q*h of first water. If known r. <br /> This well was I nqt mV Jtarirdicr ad this "port is true to the beat of ntv <br /> Standio,t level after wen corrtpletiors - ft. krtouledtte and (. <br /> (It) WELL TESTJffr *1 <br /> Sic. <br /> Wag wen test m, e? Oi5; to wl Air nJt ❑ I��1 (Wei1 i]dltee) <br /> 'type or tact �tiat wr - <br /> Jetreh n. watsr�at a 'r,f teat 4t_ � ;At and of teat is7 Rr�a�ss or rioted) <br /> S ti�a �SaI'mW a � •� n Water tempera Add tel) i <br /> `U.,:rf.lcal analylis m°°�� }}Xea Cl No I �IJSes, by whom? at, y ` <br /> -2 C."12 <br /> Was electric Eat m=51 * _ <br /> y attach this vt License N of this report - --- <br /> DWR les itrsv.7-76t IF ADDITION a 19 NEEJ]ED, USE 14EXT CONSECUTIVCLY NUMBERZO FORM - } <br /> SZ- d 010' 0N 97: qT nn, 7T ?I.-H nna)-.)77- f7T I '1 T11t0Trr —TUM„ r.l�- <br />