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<br /> AVIE i LOCATION N& CHEZ"
<br /> LL010INAL DRILLERS RLPpRT Do not,Fill in
<br /> Flit Original,Ruplitafe and Tripilcals wllb 111a ($M1641 7076.FOFP,For,,V,,,,C/dq No 96188
<br /> REGIONAL WATER POLLUTION
<br /> STATE OF CALIFORNIA Sate Well NO.—...................................
<br /> CONTROL$oAaa xo_ 5 _
<br /> (1/NTe a ro rtal...>arr Othet Sell No. =..'-.. r...
<br /> (I) OWNER: (11) WELL, LOG:
<br /> IVamc
<br /> T...I dm,h ft. rh o!c/mpk.[.d r.11 P rk 0p,
<br /> Address O R.rmr,iun,orIPOh h rofar,rb.arin,Ilii al w.er.,d,..d 111111/rr.
<br /> fi. Top sn'll
<br /> 14" t ,1 A_Lya I _
<br /> (2) LOCATION OF vELL: 14 961, amnd
<br /> C my s Or.rr'1 e,ems.r.if.a►^ .
<br /> rl,F.D.or s,ra,no,
<br /> 71
<br /> N 8
<br /> 95 104' Gy-aval
<br /> 1104 1 art
<br /> -011-9-7
<br /> (3) TYPE OF WORK (check): P08 Rand
<br /> 208
<br /> - &
<br /> New well [ aeepcains C] Reconditionini © Abandam 0 sand !
<br /> It 44sJowme.1,dr,rrfbe nulrrlel rr,d proefdwre is lr,m 11, _
<br /> (4) PROPOSED USE ([beck): (5) EQUIPMENT:
<br /> Domestic ❑ Industrial 0 Municipal❑ Rotary Q
<br /> Irrigation 10 Test Well ❑ Other ❑ Cable 9
<br /> Dug Well ❑
<br /> (6) CASING INS'T'ALLED: If gravel packed t
<br /> S1NGLE.V DOUBLE;, cootr' „ 6i,mnrr l.em 611 ••
<br /> (COIR {t_m it. Dire. Vali /!I6e If. f4 I
<br /> 1 QA
<br /> SO 212 '- 4 121,
<br /> 77P.and sit*0 rho..,.01 ri.a silt of sn.tl I
<br /> Dwriw join WAIdad ••
<br /> (7) PERFORATIONS:
<br /> Tr"of onlxetor wd
<br /> size
<br /> AQ
<br /> (8) CONSTRUCTION: „ »
<br /> t
<br /> t,r.r{111114!N.Itrry IaI At/.,ddF []Y.t M Ne Ta rMr d.pik It.
<br /> W-14 407 111441 Ndrd 1[61444 y/Iret{e.f 0 Yet ❑ N/ It p6,Dot.drpih.1 awe. ..
<br /> method of Scaling morl rt.r,d B Is c.mnln.d TT �O 611/
<br /> (9) WATER LEVELS: FELL DRILLER'$STATEMENT:
<br /> This u41 wet drdlled wnler my jrriidirlion rmJ,bit rrparl i,erwe to Jbe 14i1 of
<br /> Itrp,h rr wire►14161..,am f1x/d40 !,. my Aaandf4ge and belief, .
<br /> sandinc l.ai Mfmr p.,l.ruinR 1r. IYAA[F (� ilil`^L1 1
<br /> aeudrne Ir.e1 alar lwrl.nN^e fi. ll.emn,nem, .ueraru�,.. .1 tp,J m e�.•hJ��
<br /> Addn4r Q537_RiverRoad _
<br /> $M3Nca �... ....,..
<br /> Mod ...—...._._........ ...1 .
<br /> (l0) WILL.TIJSTS:
<br /> s'a r pwnp.nt mrd.l QYn r)1r'a [t ME?rh.r.T Us �
<br /> Y,dd: ��AA� .�1./mi/.mit! ft.A—d/r..fw hal. f 1...,....'..... .'`. p .._•.4df fMlffn ......... ...••
<br /> 7w.outlwe.!�aeu ern.rh..d..f..dr,i.nrrdrF ❑Yn Q N. 2012.48.........._. Dated....._ .. .. .. .(9., .
<br /> LiunuNn._. .. .. '
<br /> Wn r[..rrie 1/e s.h/f idle C Yn O No
<br /> /T/i//•n wN a4iM //O OWR 199 draw.a•54k
<br /> F
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