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f ORIGINAL STATU OF CALIFORNIA ' Do not fill in <br /> THE RESOURCES AGENCY <br /> File with DWR DEFAFtTMENT OF WATER RESOURCES No. 227013 <br /> jjQn of Intent NoWATER WELL DRILLERS REPORT Stam Well No <br /> ¢trait No,or Date 81-605 Other Weli No. <br /> INWW <br /> (1) OWNER: Name _Marie Ao47e _ T (12) WELL LOG: 'total depth +�4&jt.Depth of compkcted Nveil-I Akft. <br /> Addre 7456 Andrea from ft. to ft. Fommtion (Describe by color, character, size or material) <br /> city t:oc ton, �a 0 -- 7 rd a <br /> (2) LOCATION OF WELL (Sea instruetiolls): <br /> Coup7 - � land <br /> 1'6 — 19 �a <br /> h "SiiY! Jia-l}L�1n.,._„ -Owner's Wari Number (�, and �= <br /> Well address if different from obove 1(J <br /> Tnwmhip 9 2_" Range d� sacti ay <br /> Distance from clties,mads,railroads,fences,eto Same address 49 ' <br /> 60 0\4ng <br /> 80 <br /> 9M,,%,C#and <br /> (s) TYPE OF WO]RKj a <br /> Now Well X Deepening ❑ — an <br /> --�� Reconstruction ❑ <br /> Reconditioning �] -- <br /> V A- Horizontal Well ❑ <br /> Destruction Q (Describe — <br /> ` destruction materials <br /> ij procedures in Itom — <br /> f GLS' A (4) PROPOSED Dr <br /> r I llometio [ <br /> irrigation09 the <br /> ❑� ., � <br /> Industrial Q <br /> �•} �� T Well <br /> ;.1 <br /> S'-rlf.;s Municipsl�l j \� <br /> WELL, LOCATION SKETCII Other ❑ <br /> (5) EQUIPMENTo (6) GRAVIII. ACK: �F- <br /> Rotary [x Reverse ❑(° Ex No Siz (- <br /> Coble p Air ❑ `, tter of boracc <br /> Other ❑ Bucket ❑ <br /> (7) CASING f <br /> INS'T'ALLED.( ' (8) PERFORA IO <br /> o <br /> Steal 0 Plastic M Co eta Type of piq�s e of sceeer�j <br /> From Ta Dia. Gito-de 1 To Stiff - <br /> ft, ft[ din. Wttll <br /> 0 11}I t- 160P70 110 14CI� 1 <br /> (9) WELL SEALt a <br /> Was surfece sanitary seal provided? Yes i% No C If yes, to de ptb__j0L_ft. <br /> Were strata sealed against pollution? Yes❑ No Interval^� It. — <br /> Method of scaling-_ C em end Work stortad Complat islL <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, If know--. ft. This well euro drRled under My jari (601.1 thfs report h true fo the ben of <br /> Standing level after well Completiont. knotufedge elief. <br /> (11) WELL TESTS: Slcs 71— <br /> (W I Driller) <br /> Was well test made? Yes ❑ No IM If yes, by whnm? <br /> Type of test Pump F1 Baller[] Air lift❑ NAME_ Pane�ro Vel ril.rota a IncL_ <br /> Depth ,ta water at start of test ft. At end of test A J�a orLsati � rted) <br /> ress <br /> r pischarge�_.—gal/min after hours Water temperature Add <br /> Gary (�g�dg]�e Ca1i� 7j 63 <br /> cal analysis made? Yes Q No 0 If yos, by whom? 7 <br /> elechdo loft made? Yes© No❑ If yes,unach copy to this report License No �' into of this report <br /> DWR We (REV.7.76y IF ADDITIONAL.SPACE IS NEEDED. USE; NEXT CONSECUTIVELY NUMBERED FORM <br /> V <br />