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ORIGINAL, STATE Or CALIFORNIA DO not fill in <br /> THE RESOURCES AGENCY Q <br /> File with DWR DEPARTMENT OF WATER RESOURCES NQ•3`'(�'16" <br /> lice of Intent KD _ _ _ WATER WELL DRILLERS REPORT State Wen Na <br /> Local Permit No.or Date Other Well N0.<_, r <br /> WNER: Name (12) WELL LOG; Total deptlr_�ft.Depth of completed weii 1 52J1. <br /> Add frtm5 ft. to ft. F'ormntFon (Describe by color, character, size ar mato") <br /> iib'-,_SCfalrt Ql7.y �%a 19 i'nrni� zip - <br /> (2) LOCATION OF WELL (SPL instructions): 4 18_ <br /> C:nmty t5'ap,_j Owners Well Number22 <br /> Well address it dilftlent from On - wn <br /> Q <br /> Township nuge Sectio 28 2 San Ncoarse <br /> Distance Iron:cities,reads,r dreads,fences,etc. 32 -- ,-46 el x'OWYl <br /> 6 60 \ d & cls <br /> 60 - <br /> 6 sand brown <br /> (3) TYPE OF WORK: 78 , 80 clay brown <br /> New Well M Deepening E3 80!- 84 sand brown <br /> Rer»nstruct(nn Q 84. "-` 8 Oue CZ <br /> Reconditioning 0 � $ - g1 d & clay <br /> Horizontal Well Q 96 Z.l1Q al <br /> Destruction 0 (Describe f <br /> destruction mat ab d <br /> procedures irr I1cm I uW c' <br /> (4) PROPOSED ' Eli¢ c o and <br /> Domestic , - sand, <br /> Irrtgatfo � Cl$. <br /> Industrial 40 ngad & clay <br /> T,e Well 0 ` 7), 1 Band a offs se <br /> O <br /> sto _ I cl <br /> Munic( a <br /> WELL LOCATION SKETCH Other <br /> (s) EQVIPAIBNT: (6) GRA PACK: U <br /> Ilotnry ji lieverse ❑ j'es= Na Si f� <br /> r� <br /> Cable Q Air 0� ter of bora <br /> Other Q Bucket qt <br /> t t� <br /> (7) CASING INSTALI.EA `` (8 �BERTOA?k• S: _ <br /> Steel (? Plastic Q C @ Type of VqI 1'l o ize of <br /> Froin T . IliaWDr Fla To �5iL�1? - <br /> ft. si in. Wall f * - <br /> - <br /> �, v <br /> (9) WELL sI:AI.: <br /> Wns surface sanitary-seal provitled? Yes No ❑ If yes, to cieptit50 -ft. <br /> Were strata sealed against pollutlon? Yes Q No Q Interva? ft - <br /> �' Method of sealin Rentonj Work started - 18- Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEXIENT: <br /> Depth of first water, If know ft. MIA well u v drifted tinder my fgrtsdietion and this report fs trice to the best of mit <br /> Standing level after well r-rnnpletion 50 _ ft, knowledge and belie/. <br /> (1I) WELL TESTS: Sm iso <br /> Was well teat made? Yrs to No Q if yes, by whom? (Well Driller) <br /> ype of test Pump Lt Baker t] Air lift IMAM j et OTe Noack & Son. Ing. <br /> Depth to water at start of test ft. At'end of test-ft (v r,firm,or eorporaVan) (Typed at printed) <br /> Dischnrge tral/lnin after--hours Water temperatu AddreCCs��s}}.,�p,�1-�Y{a� O%��ng g9201 - <br /> -remieal analysis made? Yes (3 NO❑ If yes, by whom? City��l0' tQn n�-`a 7;P�,--J1�+�-t- <br /> "-a o I log mnde? Yes ❑ No Cl If yes, attach copy to this report License 1oti 2OQ 794 ---------Date of this report <br /> 99 tgEV,7-78y IF ADDITIONAL SPACE IS NEEDED. USE ,NEXT' CONSEGUTIViwLY NUMBERED FORM <br /> 7 <br />