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Mar 05 07 01:11p NCYC PLANT OPS
<br />SCbClC.tOri µomens COiTeCCioA31 'f2Ci+11<y
<br />209 948 0824
<br />OUG INAL IrrAYE OF CALL FPORN I A
<br />THE RESOURCC3 AGENCY
<br />Fite with DWR DEPARTMENT OF WATER RESOURCES
<br />' of Intent NO_ WATER WELL DRILLERS REPORT
<br />L,,, - rermit No. or
<br />P.11
<br />Do not fill in
<br />Na;. 192060
<br />Stere Well 'No
<br />Other Wan i,,.0/AJD 7E
<br />1 OWNER:;-�.✓�ff�/°-
<br />{ ) Nante—�- U
<br />Q
<br />AdtLea !` 3�'?G �% Q
<br />��."�'CSZSO � '�'.a
<br />Cir STdr-rani z;p
<br />X12} µELL ���t
<br />LOG: 36
<br />Tvc,l depth.�u Ott. Depth uF rtmrpktxd volt 5 ft.
<br />Farm it to it. F ormntinn (D—ribe by r
<br />.ttior. chnraCler. ,im nr m. terra]!
<br />-3
<br />-
<br />Heavy Ton Soil
<br />Clay
<br />(A )sLOS-a` TToatlOF�WELL (5cciastruetions): �
<br />Owner's Well \nn,be: ti.
<br />%V&G address it different frnm ftbove
<br />6 - 4A
<br />B ritcl.e Clay
<br />48 66
<br />Soft B`, i)wn Cla
<br />/ e7
<br />Tnwrlship � 1 Ront;e 7' - Srctinn �^
<br />Pram cities, roads, railroads, knees, etc t mile east of
<br />Newcastle AV, ,1/8 mile south o f Arch Rd.
<br />LnEtO
<br />66 - 70
<br />70 - 75
<br />1 75 - 82
<br />82 -
<br />Fine Sand,.,./'/nistanee.
<br />Coarse Sand
<br />Soft •Brown Clay
<br />Sanc a, Cravel,
<br />N.
<br />Arch Rd
<br />j
<br />( 9) TYPE OF WORK:
<br />New Well k Urrlseninp ❑
<br />Retrmsisuction 13
<br />Arcrmditirsain� D
<br />i1..riwntal �t•rll p
<br />ilretruetion C) (Describe
<br />dttstrurYiun mareri„ki: arrd
<br />pnrc iur,s m Item i?)•'-
<br />PROPOSED US&-
<br />Dan,exrit 0
<br />lrri�nlun '; C7
<br />lndurcriaf O
<br />Text Nell a
<br />Sht1'♦ G
<br />telun�ipal �
<br />Other ❑
<br />85_
<br />� -
<br />1171 ra
<br />..
<br />Z -
<br />f
<br />_
<br />141
<br />•• ♦ -
<br />�..
<br />lay
<br />B Tu e : C 13y
<br />�{r(a
<br />gZuC! Y
<br />1.4-1(4)
<br />1/8 mile
<br />Mile
<br />f � -
<br />6— - 370-
<br />6
<br />Blue Sand
<br />37 - 380=
<br />_
<br />B111e" Cla
<br />380 - 385
<br />Blue Sana
<br />385 - -'400
<br />Blue Gla -
<br />WELL LOCAY .' SKETCH
<br />-
<br />751 gouiP."tl:NT:
<br />Rr,aln' Rrvrrtr C
<br />(:anie i] Air ❑
<br />tither ❑ n,rrknt 0
<br />(fl) GRAVEL PACK:
<br />Yin t No C) Slrr well
<br />Drnn,rter of torr 281t
<br />Prt:krd_fram 0 ';._36. 5.,.,_.�Il.
<br />e -
<br />_
<br />('.) CASIVC INSTALLED: .-•
<br />steel (� plait ❑ Cuuretc 'p
<br />(H)'PRRFpRATIONS;-
<br />Typo? or f,r'(yratlun or size of careen •
<br />Frol:l 1`o
<br />Dia, Ga�� or
<br />ill. wall
<br />Sot
<br />k r(n7l To l
<br />Ft. fL site
<br />-
<br />-
<br />0 130
<br />14x 5/1.6
<br />130 190 ss Za .0651
<br />-
<br />19C 230
<br />140 5/16
<br />230 345 ss 8 a 10651
<br />-
<br />345 365
<br />10 s
<br />-
<br />(9) WELL SEALt 41 blank above ground level
<br />\yn> wrface sunitary seal pnwided? Yet :x NV M 1d yes, to dept eh fl.
<br />Wcre strata scaled astainst Pollution? Tex N No ❑ Interval 55 eft.
<br />Method of xrafinr �+• rnmL
<br />_
<br />-
<br />_
<br />Work starteA_
<br />~ _
<br />(10) WATER LEVELS: r r
<br />Depth of first wale•', (( known- -� 0 .... tG
<br />Stn+dinf level aftct well t•omn)etitm 50 t h•
<br />�VELL DF LLEIl'S
<br />V#4 u c(1 uusr dulled uncinr
<br />knowledar and bsLtVj_
<br />SIG,,,, L n
<br />STATE44ENT:
<br />my juArrlirlion a..d thir rrmsrr it trite to the brR nj my
<br />(11) WELL 'PESTS:
<br />Wa+ well test rnsdr? Yes 12'•1 N;3 0 It yet, by Wht>�
<br />'P> 2 ;ee t.f her Pomp Dailer C Air {tit M
<br />Depth M µnem at Siert of test—,d.-3t. At eras of rest Fr
<br />D'�-�wry;t ._;a,l/min a!tor h;,un Witter t6mperrit
<br />1, ml acalysis mpdre Yet :3 fin 2 if era, by vvhorn?
<br />Wns rleut,ir Inr rrtadro Yes No •" If "S. Limich rim• to this mnnY,
<br />y (Willi Driller)
<br />?AME Ar r llU & 0 -rum Well Dri 11 inti G4 , L 1nC , _
<br />(Pfrsoo, tirm, nr cc -o atitm) (Typed or Printed)
<br />Addre4s-3262 Coae;b �1V@
<br />Oily rT e s nO , C2 . z. Lill 7 nn
<br />3 7 25
<br />Lieenxr- tva.361319Ibis n ,i 11••7-86
<br />Ste u: !lull
<br />awn tea tP£v. t -•tar IF ADDITIONAL SPACE 15 NEEDED, USE NEXT C0N5ECUTIVEL,Y NUM5ERED FORM
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