Laserfiche WebLink
ME—Pigs <br /> i <br /> f <br /> 1 [ STATP OF CALIFORNIA <br /> OUADRUPLICATE rHE RESOURCES AGENCY De not fill in <br /> ' Use to comply with DEPARTMENT OF WATER RESOURCES <br /> laccsi requirements 1VATER WELL DRILLEiWS REPORT No. 295391 � <br /> iceruf Inh•nt Mi til:dr Well Na._ <br /> LiK:rl Permit Nu.or D:dr s $• CIO"� �'-- —� Other LVrll No <br /> (1) UW Nt:R: N11r3r• iiti)l:i� :•FAIT�`:il__'•! (I'�} W11,1.1. LOG: Toll Iit•}1111 �+ Ii t.enllllll'teYi[Ie'llt}e lt- <br /> Addrrsy <br /> fn ni It- a !t F,rnl.rtion(Dvii fit 112'color,charue•Ic r,s1;c nr rn_lrna]) <br /> (,fly ir751i1=ir Grt-ri_ _ _ <br /> (2) LOCATION OP WELL(Sec inslruclionti): � <br /> Count 3 rJ in41PY 4wurrs Weil Nnmin:r t( <br /> IY't'E1ads1r(:lt if 111 ffr•rent,frrlln alxi%,e rev,'^ 11.1 t;.0 I � <br /> { Tnwriship^..�_f:angv Setitiou <br /> }! Dittarlce from cities.roads,rallrc id%fellct-,CIC. <br /> TIT 1r'7f e=c'T" •1, 12 r_t"a_ It".l'� W*1 .-1 _ 1 <br /> It•'rryc�_tn •.� .h <br /> (•'t)'rvvi:011 1VC}llf:: <br /> { � Iie"witnlction ❑ "" i �, <br /> Ilori-rit.rl Well ❑ - <br /> C3 (Describe <br /> Destruction <br /> drsinlctiun rnaleria}s and pro- <br /> etYhlr-in Itern 12) <br /> 1 ( (4) PROPOSED uSL? <br /> _ Domestic <br /> k[-�3 Irrigation <br /> Industrial ❑ �� _.�/� e:.',< <br /> Test Wrli ❑ tN <br /> La v,c, hfuuicl r1 ❑ 1 1 <br /> OFLL WICATION SKEf'CH e r.•nlm) `� .`� `t`_,.�r ".r.• <br /> s <br /> (S) EQUffrMENT: <br /> lirtary❑ fle((((e ❑ No <br /> Cable ❑ Air ❑ i12clr•of bmr <br /> \tV \ 1 <br /> .I Otho ❑ Q1rck a fd From <br /> (7)CASINC IN5rALLED <br /> '. Steel I� Plastic - <br /> ` ❑ TypCrffor�ationarsizeof�crers� <br /> ` \ <br /> From o D' . Cage or. � r}onl Thi \ /�SEot — <br /> If. L Wall <br /> (9) WELL SEAL: <br /> Y/_ _ <br /> Wassurfacusanilarysealpmvided? Ye�_%6.Q=-If MI.depthft. - <br /> Werestratawaledagaiistpollulfon? Yes ET No❑ Interval Lft _ <br /> A1etllaEuCsenting a A' Work started 19 ^ Gonlpletmi l9 <br /> (10) WATER LEVELS: WELL DRILLERS S•CATEMENT: <br /> Depth u!Eirst water,if Lnown !t <br /> Standing levelafteewellrnmp}Mian 4.C�e �Q fI. Thfs urll tens(trifled Rader my jurisdiction and this report is true to the <br /> b1st of m1l mm,ledge and tx hef. <br /> (11) WELL TESTS: <br /> Was well test made? Yes❑ Nn❑ If ytt by whnrn? Signed <br /> _of test Pump_❑.- [sailer <br /> _C1-_ UL O_ - iV - -- r- -,Iti 1�"- rY r- �; 4-fV v- -- - _- -- - - - —-- - <br /> I lery, <br /> !" <br /> hlowater at start of lest ft. - At erul of trst - _E[ ecze firm,or cvlq tatiee ed nr (.:.led) - - <br /> Discharge gal/min aller hours 1Vatertemperature Address- - _ <br /> Chemical analysisnwde? YIs❑ No IFy17.bywh.im? City' ZIP <br /> WaselniriclogmAv Ye,;❑ No E2' IfYtxattaehropytolbisrelx.rr I.fcensaNn <br /> _ _ � Date of this report - <br /> orie les 1REY.12.66] IF ADDITIONAL SPACE IS FhEDED,USE NEXT CONSECUTIVELY NUMEiERED FORM - - <br />