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ORIGINAL STATE OF CALIFORNIA Do not flU in <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 198002 <br /> of Intent No— WATER WELL DRILLERS REPORT Stats well No <br /> ' Permit hu.or Da zT — Oth <br /> er Well No S�25 C) f E"'aP 3 <br /> (1 OWNER: Nd �7YI /l !' / (12) WF'LY' LOG. Total deptlL&.� Depth of eamplatM-djzol t <br /> Address &/ from f6 to fk Formation (Describe by color. character, size or matarlal) <br /> ' p Q r <br /> (2) LOCATION OF WTU (see mstruebous) <br /> ConntY 0 Owners Well Numhsr <br /> v <br /> Well address if different from a y tr - �. <br /> To+vaship Rama Qoc <br /> Distance from cites,roads,railroads fences,etc e <br /> Aq 17- \` 5 99 <br /> 23 1,07 <br /> (3) TYPE OF WORKi rn t <br /> ' 1r <br /> NOW Well-k Deepening ❑ w <br /> f Y Reconstruction p g �n <br /> Reconditkming [3' <br /> �p1 Horizvatal Won 13 <br /> Destruction ❑ (Dawribe — ]yJ destnution materials all — <br /> procedures in Item r f <br /> (4 )PROPOSED — 1 ^ , -- :7r lrX�✓S <br /> Damastic `• <br /> Irrigation ❑' '�� <br /> industrial <br /> T Well ❑ \ <br /> Murtim v <br /> WELL LOCATION Sl(LjTCIi J Other ❑ <br /> ' (S) EQU17MENT (a) GIIAY L ACK <br /> Rotary �q[J Reverse ❑ � NO Size * 'V <br /> Cable {3 Air ❑ M b of bore <br /> Other ❑ Auck- Q <br /> (7) CASING INSTALLED, 8) !?IiRFOHAY{b1 <br /> Steel❑ twd.A Ce Type of or a of sareo <br /> From Tu, Dia, G'ka:dr F .,1 To <br /> ft. ft 'Ez>. Waal ft £t. ( s — <br /> ' 4 1 R', & bass 10 ! - <br /> ti` IGo - <br /> (9) WELL SEALt —0--ft <br /> � — <br /> was,surface sen tsxy seal provided? Yes, No © If yes, to dap <br /> %vere strata sealed agdbut p <br /> ' Method of seaiW r Works 45 Camplet 9 <br /> (10) WATER LEVELSslQ WELL DRILLEIVS STATEMENT <br /> Depth of Ant water, if kaosvn Thfi wall soar drUled under (urisdfcrfoa and this is trud to the bee of rap <br /> Smadrntr lavd after wall eample knowledge and belief i <br /> (11) WELL TESTS. Cle an au u11 SION <br /> Was well tact mdde? Yes 8 No ❑ If yet by whom? (W <br /> Type of toot PU-P Sailer❑ Air ukR NAM Leal' Ie7 l/fes <br /> Depth to wafter at soot of t & —ft At and of tis n. or cor (Typedor panted) <br /> Jpr�a '1� adl/mia slta�rurs Water tempem I Addm�, — <br /> ' cal analysis mads? Yes❑ No`s If yes. by wham? City.•. .. <br /> rs electrid log mndo7 Yes❑ NoNZIf yes.attach copy to this report License N ass of this report lZ 9RA <br /> R 180 (Rev 7 76► IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECU'T'IVELY NUMBERED FORM <br />