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luk[SINAL STATE OFCAF_1FORNFA Do not fill in <br /> THE RESOURCES AGENCY <br /> File With DWR DEPARTMENT OF WATER RIESOURCES No. 36118 <br /> Notico of Intent No WATER WEIrL DRILLERS REPORT State well No <br /> L, ermit No.or Dnte Other Well <br /> 1 WNEH: ivamti iPt,r,]ra�rfsr, (12) WELL LOG. <br /> ' Total depth (t.Depth of completed,vol1--ft. <br /> Addles from ft, to ft. Formation (Describe by color, character, size or material) <br /> Cay ,0/ z(p 0 - 6 Adobe <br /> (2) LOCATION Of WELL (See instructions): f° - 18 clay <br /> Cmantyaz -joa=12_L�, Owner's Well Numbet 18 - 23 sand <br /> Woll address if different from ah.,.—U3 t -iV. PeYghmn 23 - 53 Cls <br /> Township - unnge_ sectio - 90 Cl � <br /> 53 - 59 sand & g1' .y <br /> Dittaace from cities,roads,railroads,fertacs,etc <br /> 90 - 93sand ' \\ <br /> 93 - 1 C a <br /> - sand <br /> (3) 1 YPE OF WORK: <br /> -1-23 /P198 IN11a clay <br /> Now Well 9 Deepening ❑ <br /> Reeeastnrctfan ❑ 12R _ <br /> Reconditioning Q a , <br /> Horizontal Well ❑ -155 Xdu- C a <br /> Destruction f7 (Describe --164jj B igand <br /> destruction mato"' <br /> procedures in Item - <br /> (4) IPROPOSED 81 . <br /> Domestic <br /> Inigaiton�� <br /> Industrial Q <br /> t well ❑, <br /> SmZ - ,0 4"o <br /> ' WELL LOCA7'IOIi SKETCH Other [l - <br /> f.1) EQUIP\1ENTs t(6) CRA[ <br /> \\I A Ko <br /> Petery [� Reverse C) Tis Ll Na` Size-- <br /> Cable 0 Air ❑'�- \r1 to of bore � <br /> V <br /> Other ❑ <br /> Bucket 0 <br /> (7) CASING INSTALLED- (014ERFORA l St - <br /> Steel❑ Plastic El Ce Type of pa n O ze of scree <br /> •rain T Dia. r Fl�oo To S�r� <br /> £t. fr in. Wall £l� ft. s, - <br /> 19A 1-64ME <br /> (9) WELL SEAL: - <br /> Was surface sanitary sea[providedP Ye No ❑ If yes, to depth-551._!t. _ <br /> ',Vere Strata sealed aua,nst pollution? Yes No C3 Interval ft. <br /> Method of scaling--g Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLCR'S STATEMENT: <br /> Depth of first ~rater, if k=%Vn - --- ft. This rueii teas drNIed under my 11+rlsdiction acid this wort'D true to the brat of mp <br /> Statrdln$c level after well oompletiorm fr, knotolsedge and belief. <br /> (11) WELL TESTS: Si0ivLn.__1/4.c 1.f-.=-= C_ MGIBCZLrx An-n- Tnc <br /> Was well test made? Yes Q No p It yes, by whom? (Well Driller) <br /> Type of test Pump a Hailer 0 Air )[ft(] NAME <br /> Depth to water at start of test Ft. At end of test ft (Person.firm,or corporation) (Typed or printed) <br /> Discharge cal/min after hours Water temperature AddresBX 9O8 <br /> ' 71 <br /> Chemical analysis made? Yes [( No ❑ If yes, by whom?MaCity kn <br /> Tic log made? Yes C No ❑ IF yes,attach copy to this report License No a of thus report _ <br /> L Ba (REV.7"76) IF ADDITIONAL.SPACE; IS NEEDW. USE NEXT CONSECUTIVELY NUMBERED FORM ♦sate-aser.,eI.MOUAopt Or OSP <br /> 6 <br />