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ORIGINAL STATE OF CALIFORF41A DO not fill in <br /> THE RESOURCES AGENCY n� <br /> dile with AWR DEPARTMENT' OF WATER RESOURCES N0. 41803 � <br /> 3:Nntiee of intent Ila 'WATER WELL DRILLERS REPORT State well No. <br /> Local Pcnnit No.or l)nte . � Other Well Na. ��•� <br /> I <br /> - r i <br /> ( WNE�R: �,an, 3ahpAn Boesch (12 WELL LOG: I. <br /> 228 74 NQrth R� Op Road � Total daptis (t.Depth of completed we1l.,L1td_(t. <br /> 'r� from it to ft. Forrnmfon (Describe by color, character, size or material) <br /> city on. -0a i% 9 5 3 6 p - sen some as a <br /> (2) LOCATJON OF WELL (See instructions): 27 ^ 31 br al_yLailty streaks <br /> Crnrttty§8X1 JJ 040— 11 Owner's Well Number 31 - wilt sandy OZ <br /> y <br /> J i Well nddress'if different from above � yC.�� tough 0 . rock 1 <br /> Township Aange Sectio 48 ^ 58 couroe sa oryl <br /> Distance from cities,roads,railroads,fences,ttc. 58 -- 5 m 01 <br /> 5 5 sa ry <br /> 5 - 7 bra lj ohs <br />( 5 - anCL <br /> (3) TYPE OF WORK: tV1 oil <br /> n f Ncw Well X Deepening 0 867v BaTli3 F7fZty Sall <br /> j� T1 t/rtT4S Hecnnslruclien0 90 — <br /> SS & <br /> ►►t(\� r(-rVC �rri•~tel` Iiecrmditionirtg d — Z'' <br /> Ilvrizontal Well — 113. as nd <br /> . I S"y . , e,J nestruction 0 (Describe '� - 122 br 01 V1*8 & ailt streaks <br /> r X11 destruction materials <br /> > � p dures Jn Item 12 90 �[ O Zt OZ <br /> r (4) PROPOSED X1.2 - M13.d to Zeen br oZ <br /> Domestic CrG couro a $maZ grvj <br /> Irrigation3, — � OII <br /> I' `C IndustrialO Z �JjO CZ6}�A Z. $a)I]i� <br />{ Wei1% 0• �4Z r OZ <br /> s - 14, br sand & ' <br /> pl t <br /> P s sf14> 9 & brittle 03. <br /> ►YELL LQCATION SKBTCfI Other © — t3 1 <br /> j (S) KQVIPAIENT: (6)-GAA PACK' j <br /> Rotnsy © Reverse ❑ q No S. ,I <br /> Cable �1' Air Ej r�t ter of ho <br /> Olhar [] Bucket U 2 tti — <br /> (7) CASING INSTALLED (B) 1FERFORA 5: <br /> I Stcelxl Plastic❑ Ce c t Type of n or of scree — j <br /> From TO Ilia. C r F To — <br /> s ft. f > n. Wall f ft. sf - <br /> �? I 1.0 - I <br /> I <br /> (8) WELL SEAL.- <br /> # <br /> 1 <br /> %s surface sanitary seal provided? Yes 0 Nog{ If yes, to depth <br /> Ware strati seated against pollution? Yes q No JX Interval _ ft. ^ � <br /> Method of sen' Work started— 9 Co <br /> mp1 » IB <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known, ft- This wolf was drilldd at r er(rdictin and this report IQ true to the,best of my 3 <br /> Le(ie/. <br /> Standing level after well completio 4--nowledge and <br /> (17) WELL TESTSi SIGN6 <br /> Was well test made? Yes 0 No +g If yes, by whom? (Well Drnlor) : <br /> Type of test Pump a Bailer© Air lift 01 7 Z } <br /> \fA,tiIF,_ PUrV�. 09�rj.ZZsxB <br /> Depth to water at start of test_ ft, At end of test (Person,firm,or corporation) (Typed or printed) r <br /> o YeCity Linda ox �t <br /> ISLmhargo _ <br /> __ _gal/m!n aftcs hours Water tempersehu <br /> Addrets •- _ _�6 <br /> Lhemieal analysis made. s 0 No D If yes, by whom? ri- �j�'—�_ r � <br /> rsctrtc log D <br /> made? Yes C) No 0 It yes,attach copy to this report License No. ate of this report_-70-10—r/7- <br /> l <br /> 198 (RBV.7.761 IF A13DITIONAL SPACE IS NEEDED. USE NEXT CONae,ECUT#VELY NUMBERED FORM a.:&asv r-rs aoM QuaoOO roar F <br /> F <br /> V � <br /> !I <br /> . If <br /> I <br /> f <br />