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ORIGINAL STATE OF CALIFORNIA Do not ffq in <br /> ORIGINAL s9li T141, RESOURCES AGENCY 173121 <br /> File with DWR DEPARTMENT OF WATER RESOURCES ��• <br /> oF Intent Na. WATER WELL DRILLERS REPORT` State Well No 4 <br /> 4 - <br /> 0 42Q <br /> ermit 110.or Dnte_�8 9 Other Well No.,_ <br /> r <br /> rv1 960 <br /> A <br /> Address iinciBarbera L n. from ft, to ft. 'Formation (Describe by color, character, size or material) <br /> Oa -�ipr9 5G 0 -10 Sandy Soil <br /> IQ —21(2) LOCATION OF WELL (See instructions): _ } <br /> County .San ' _-�O a o u 7 n Owner's Well Number <br /> 40 Clay 4S <br /> Well address if difFerent from above <br /> Tovvnshi-R r 92 -8n Cl AV <br /> o a n __A ange Sectio I <br /> Distance from cities,mads,railroads,Fences,ore <br /> Mi . North of ` � <br /> Miqec Rd - As -113 east side k <br /> (3) T'A'PE OF WOM. <br /> Now Well)b Deepening❑ <br /> r Reconstruction ❑ i <br /> i <br /> Reconditioning ❑ - <br /> Horizontal Well ❑ � - <br /> 1 <br /> Destruction 0 (Describe 1 <br /> destruction -ate <br /> riaLs Ik <br /> Procedures in Item <br /> (4) FROP05ED <br /> Domestic - <br /> Irrigation ❑ <br /> Industrial � ❑ <br /> Tc`5 Wel] ❑ <br /> Slocl i <br /> Manicipe <br /> WEI L LOCATION SKBTMI tet,/.Other 13 <br /> (S) EQUIP111ENTt (tl} GHAV-N�FACXti&1 (�'\ 3 <br /> Rotary 1}(1 Reverse 0 No[3 � <br /> Cable ❑ Air ❑ �E) +e r of bo tt - <br /> Other (3 Bucket C1 �`,`�% al <br /> (7) CASING INSTALLED: (8} £RFOItA <br /> i <br /> Steel CI . Plastic Co c�;e Type of pe 0g ore of screen/ <br /> From Tv Dia. Gaffe ar Ft �\ To y3�a <br /> ft. ft Wall ft ft. ` i3 - <br /> 0 16 160 140 <br /> (a) WELL SEAL- <br /> Was <br /> Was aurface sanitary seat provided? Yes No El If yes, to depth�, 0 __ft. <br /> Were strata sealed against pollution? Yes❑ No [I Ltterva�__ —ft. <br /> Method of s"Ifnn gontonite Work startg 19 Completed $ <br /> (10) WATER LEVELS: WELL DRILLEWS STATEMENT: a <br /> Depth of first water, if kao This well Ices dr(fied tinder my urfedictfon and thfa report ft true t the heat of my <br /> Standing level after well ecmpletion2 ft, kno+okdtt d be <br /> (11) WELL TESTS t SICNEn <br /> Was well test made? Yes ❑ No P If yes. by whom? (Wen Driller) <br /> Type of test Pump❑ Bailer❑ Air lift❑ NAM <br /> Depth to water at start of test it. At end of lest ft (Pers firm or Corparntioa ped or prinked) J <br /> ari(e vat/min aftt� rhuafs 1 ,Water temper.% Address <br /> 3525 WL—ANDA�.E dl� . <br /> Y ! ,-. city 0[}ES7 Czip-25-336 <br /> I analysis made? Yes ❑ No 91 H res, by wl(orn?f- <br /> } lRezatric log made? Yes 0 No <br /> .IF es,attach copy to this ;HjLicense No 2 9 0 R 9 3------Date of this re <br /> rJ <br /> ITWR 168 (REV.Y•7e7 1F A13>?17}OAIAL STAGE IS IV>rEDEgP USE N>~)CT CONSECUTIVELY NUMBERED FORM <br /> I <br /> ' i <br />