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{ <br /> _ ORlGlNAL sTATIE OF CALIFOR MIA Do not fdf in <br /> THE RESOURCES AGENCY <br /> File With DWR DEPARTMENT OF WATER RESOURCES Nu.29234 <br /> N„tiLm-r Inteet Nrx TER WELL DRILLERS REPORT State Well No <br /> x <br /> fa ,rl Permit Ne,or Dot -ter r `t r k Other Well No. -2 <br /> 7: <br /> k <br /> (y )WNER- (.i2) WELL LOC: Total&Tte�L.ft.Depth u(complettd welE�ft. 1 <br />{ a <br /> Uhl -' fnen ft. to R. FogmatignAD61cribe by calor. character• sire or ararerlal} <br /> City_ <br /> (2) L N FIWELLfSee ittsttuctsons): _ <br /> CarmtY 'Owners Well Number_,.____..?_ _ - <br /> Well addrers It dillcre From a e <br /> _ � A <br /> i Township inn;e Sec <br /> Distance from cities.roads-railtvuds,fences,etc <br /> so <br /> (3) TYPE OF ORK t <br /> 4 New WeII Deepealag O <br /> Reconsltuttteu 0 <br /> -� Aeonad3efoning ❑ = S <br /> Hmizantal Well Q _ <br /> Destruction (] (Describe <br /> destruction materials <br /> rocedures to hent <br />' (4) PROPOSED - <br /> Domestic <br /> irdgatio � } <br /> f. Industrial. C7 <br /> t well � ❑ <br /> Munici <br /> WELL LOCATION SKETCH Other ❑ <br /> IS) EQUIPAiIi (B) GRA PACK, <br /> ` <br /> ttot, Rrs <br /> evee ClNo Siz r i <br /> Cable C Air Q ter of bore <br /> Other ❑ Bucket 0 "' <br /> 42 <br /> (7) CASING 1NSTALLE t8 RFOR Sk <br /> Steel 0 Plastic t Type of pe u las of scree - <br /> From T Dia. t F Ta - <br /> (t. willu ft. <br /> w _ <br /> - i <br /> (e) WELL SEAL. <br /> Was surface sanitary seat provided? Yes o-ll No Q ]f Yes to deptFr„^}Sl�ft. 4 <br /> Were strata seated agaimt Dolt a? T—11,ro Q <br /> Ntthad of "SUM. Work eta 1 Comp1 19 ) <br /> 110) WATER LEVELS: WELL DRIL S STATEM <br /> Oeytit ul fins .eater, If know Thu tae[i wv d u mq risdfes sad this upon 4 tragi to rhe 6r+s of er <br /> SlAmun¢level after. ►ell tompleti- <br /> ft. knowis�Ye oa �H- <br /> (11) WELL TESTS- 5[G� We1i Drllkt} <br /> Was teell test made? Yes Cy No Ef yHr by whnm? <br /> I Type of tear Pump Q Batter❑ Air Elft O �jpE <br /> VFW— <br /> Depth to water at start of test—ft. At end of test..-fit A� <br /> tllseltarge��l/mla sdter e <br /> West temp 9hve city ! Ify <br /> Chemicat aaalysIs made? yes ❑ No If yet. by wb—? of this►apo <br /> _W- - erre lam rowe? Yoe O Na f ,att ch c to this report License No. <br /> kee tktev.1.7e1 IF ADDITIONAL SPALL IS iVfrEOED. USE N!>Yl(T 1;PNSECUTIVELY NUMBERED FORM ssnsaws.srteraaen@rc <br /> f <br /> til'-,i nTn' ©AI 1-10- CT nn 7T AAH nr)q)-)77' nT l )TNICTn `1HNIN-41 <br />