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f <br /> SrATI1 OR CALIFORNIA <br /> /Y T THE RESOURCES ApENCy <br /> \� <br /> File i4h UWR DEPAR'T'MENT OF WATER RESOURCES Do not fill to <br /> .0 <br /> WATER WELL DRILLERS REPORT N0. 323487 <br /> Notice of Intent Na 24923 , <br /> Local Permit No.or Date 89"2228 State Well No. <br /> Other Well No, d <br /> Name 0 12 WELL LOG: Total depth ft Completed depth ft <br /> Address 1 <br /> City ZIP <br /> from ft to Ft. Formation(Describe by color,character,size or material) ! <br /> � _ <br /> (2) LOCATION OF WELL (See instructions)- <br /> county S I_4D_a-g1dL_.,.r Owner's Well Number tach— <br /> Well address if different from above <br /> Township [tango_ $l3 Section — <br /> Distance from cities,roads,railroads,Fences,etc. <br /> (3) TYPE OF WORK; — <br /> See Attached Map New Well IN Deepening ❑ — <br /> h Reconstruction ❑ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ — k <br /> Ili Destruction fj (Describe f <br /> destruction materials and pro- ! <br /> cedures in Item 12) <br /> V1 I <br /> (4) PROPOSED US _ <br /> Domestic _ <br /> Irrigation <br /> Industrial 0 <br /> Test Well ❑ � <br /> Munici ❑ <br /> O er _— Q <br /> WELL LOCATION SKETCH Vbe7 onit0 'ng \- _ <br /> (a)EQUIPMENr- GRAV j CK: — <br /> Ratary N) Reverse q No Si <br /> Cable ❑ Air © of bore I <br /> OQci ❑ Bac ed tom t; 1 <br /> (7)CASING INSTALLED: (8) YER Q ATt <br /> Steel ❑ . Plastic [� t T of I onorsixeof <br /> From DI Gage or <br /> f#. f i Wall t size <br /> (9) WELL SEAL: _ } <br /> WasaurfacesanitarysealpmvEded? Yd a Na © IF yes,todepth_�Z,—ft ... <br /> were strata mledagain"pollution? Yes fX NOD �]—112 ft, _ <br /> Methodof sealing <br /> Work started--- 1D12 . 19-34 Com leted 19,$_(: <br /> (10) WATER LEVELS. WELL DRILLERS STATEMENT: <br /> Depthof first water,if known Il <br /> Standingtevelafter well mnpletfonft This well tuns dfilled under m jurts ctfon and this report is true to the <br /> hest of kt"5'it tole a and l <br /> (li) WELL TESTS: sign Richard N. Lake <br /> Aw <br /> as well test made? Yes❑ No ill If yes,by whom? {We1 IJdI r) <br /> pe of test Pump❑ Ratter ❑ Aft lift ❑ NAME e f <br /> Deptb towater at start uf test ft. At end of lest ft (Permn,firm,ormrpo�ation)(Typedorprintcd) <br /> Discharge "min after hours Water temperature Address } <br /> Chemical analysis made? Yes (R No❑ if ye%by whom? City ZIP �A � <br /> Was electrfc)og made Yes ❑ No R IF attach y to this rt License Nlo, Weds 0- Date of this report <br /> nwR 1e9(RKV. 12-M IS ADDITIONAL SPACE tS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> e6 96335 ! <br /> 9 I <br /> 3 <br />