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- mayor <br /> f <br /> ` ~ , STATE OF CAUFOnNIA <br /> QUADRUPLICATE THE RESOURCES AGENCY Do not fill in <br /> Use to Comply with DEPARTMENT OF WATER RESOURCES a r <br /> local requirements WATER WEI,L DRILLERS REPORT N0. 299395 <br /> _`,lice of lntcnl Nu.—�� Stall Airell"N+,.'_ . <br /> .oral Pvrm4 No,or Datc741 } �'d Other Well No. — <br /> (1) OWNER: Nome lltlflC91. C:?: cF_&f in:I (12) WELL LO 1: 'Total drltth FL Campleie•d de•ptkt Et. <br /> 2,7.5 it, Csl:inz::?•x Bly(i.,3u+re �5+) <br /> Address Erma G. to 't. Garntatiun(F)exrikw 6y rolnr,character,size or rnatcriall <br /> City —%Il _ <br /> (2) LOCA'CION OF WELL(Sec instructions): — -- <br /> Cano,ly Sao .1h7+uia Owucr's Wel!Numlxr )�' �'Well address if dilEerent frnm alx+veXr]V 7 <br /> . anfe : ciiC 3VelaICG� tZ <br /> C -1'1)2;, ec <br /> Distance from cities,roads,railroads,fences,ete. <br /> NW cterner of Pacific Avo.. ae.d mnrr)s <br /> LII ;Lc�ktun. — /� •/ <br /> tat TYPL OF eW011K; <br /> New WA El Decl,ening ❑ <br /> lleconstntetiun ❑ — � �� <br /> Rrmnditiouing ❑ ^� n <br /> Horizontal Well f� — <br /> Deslructiun El (i�rscrilx <br /> _ dt:s1ruction materials and pna <br /> ecdur s in Item 12) ^ \�)� \>} <br /> 0) PROP05ED U5LK, <br /> Irrigation <br /> Industrial ❑ <br /> "I oFe-h L-Q1'\e, Test Well ❑ �\x`x/ <br /> M41nici .❑1 <br /> —rr <br /> WELL-LOCATION SKE'rC!{ >4'+'�•�ilm} _��•\�/ <br /> (5)EQUIPMENT: (� <br /> Rotury❑ Reverse ❑ � Si1p�+`t-� �� <br /> Cable ❑ Air ❑ met ofti <br /> � s � <br /> Other El B_k .M Irona.{_ 0, \, <br /> bcc)Imi 5tenr atj , !C — <br /> (T)CASINCINSrALLED, (8)PEf1lfATIONS: <br /> . I. S'teel ❑ Pkut€c e Type oE�e[arafion�oJJr simnjre+i _ <br /> Fromo P Gage or i T1 �/3fi t <br /> ft. f tai Wali — <br /> �. <br /> (9) WELL SEAL: — <br /> Wasatrfsmaanit�rysralprovldrd? _ try <br /> Were., seared against pallullon? Yee fl' Nn❑ Interval <br /> 1slNhod of sealing ` Wurl;stattc•d t9 Completed 1 _ <br /> (]0) WATER LEVELS: �ilELL DRILLER'S STATEMENT. <br /> t>.•pth I first water,if knr n Ft. <br /> •-- ------ --.... is well ax_drilled.nr r m 1} _ _..--- — ---- ------ — ----------—-------- ----- <br /> -------------- -- - Th c utdc r .urtsdtctlun Diu!this report ft true to the <br /> - Sundinglevelafter wellcotnpktion - -- — ------- -_.-ft. Lest of m 'nou:fedge and Leftell. <br /> (11) NIELL TE$TS:. Signed ��+ <br /> : Waa welE test nude? .Yes C1No z IF ym by w�hon'? 11E'e[,lyrillcrl <br /> - pc of test Pump❑ Bailer❑. Airlift ElNAME �/ �Si e, I—.'. f. '•'a /,f,+-� r <br /> llh to water at start of lest Ft. AS end of test ft SPersoR firm,or rpnralso ITygxf or printed) <br /> , iscEurge - gat(rnin after - l+onrs- . %Valerlemperalure AddrrKs <br /> Chemiralanalysisr,rade? Yes No,6 lf)mhywhnn+? - - 01%, - -ZIP .. <br /> -LVas elec[riclijunde Yrs❑ No�f If yts.alt_ach copy to this report - l.invtse No. Dole of this relxtrt <br /> _ I IF ADDITIONAL SPACE IS NEEDED.USE NEM CONSECUTIVELY NUMBERED FORM 86 46355 <br /> owls 186(REV.12•58t - - <br />