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<br /> QUADRUPLICAtt z
<br /> ueVft with STAT[OF CALIFORNIA
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<br /> focal nqufremenK.
<br /> THE RESOURCES AGENCY
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<br /> DEPARTMENT OF WATER RESOURCES NO Z4CJS
<br /> I err frrten!'xn_ -- WATER WELL DRILLERS REPORT...... ti+�re welt j '`"ry
<br /> trend Permit xa or Dnte 27-6351 W : 01f ei Kelt Ufa Cir f�a r ";
<br /> (1}:OR'1VI'".Ii Hnme_�'�+Q�' (12)' WELL LOG Tata1_deptiLi DevtL rel rnmpktEd week.
<br /> R Friimatfmt':(f)esertbe hf•minr c6rr>rrter rite rh irtrhe11111�
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<br /> (�) LOt.ATI NOF WELL See.iaatnit Nnrts)
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<br /> Owner's\yell Number65-83.
<br /> S1 all riddres.if dFifern+t Frr,m abase - L'�. .r -` itw `•'�".�+K�a!'�ftr"
<br /> 1 armhip� ri r1IIe'. -_�.SerNn .
<br /> ' 17mence!inns cites,mads rallrrtads lenc, etc `
<br /> 3 �: .:iS.-' 1 -'� .:,firm� ��+1�cY�. h "•'l � I{`e1
<br /> ! !31TYPE,OF,:WORKi
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<br /> ' \ew \Vell� Deet+enln�❑ '- a,i'xt '•+•»n°ae�•v�=iw•`�.r�+�+. {.
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<br /> i- Hmlmntal LCe[1 ❑ s• b° " w�
<br /> Destroctlnn[] (Describe
<br /> i dtstmetim materials and
<br /> Prrxrdum in )tens 12)
<br /> !A) PROPOSED USEr
<br /> Domestic in
<br /> Tat Well ID••II �-fir -. r��'"• �`i-��+�, I
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<br /> Municipal- S..r
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<br /> ' WELL LOCATION SKETCH - '--. Other •..: . ❑ - - -
<br /> (S).EQUIPNEI7 f e)'GRAVEL PACK:
<br /> 'Reverw CL Yes X.-,N*n;D S
<br /> 17 Ra1"ry. ° _ _
<br /> '1 Cable ❑ r 'Air D Maineter of bare .
<br /> . Other ` Q- ' 6uckel ` ❑ y l?acRed:Finns 'tn t � ;����;rr
<br /> (7),CASINC S\5TAL1.EOr:,--. (8)`PERFORAT1ONSt -
<br />' Steel•. Plast➢e,❑ Cns.crMe C.' Type of perfnrition nr.size n screen,..
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<br /> I, Erom To bia, Cat~t•or Tram To Slot v
<br /> ft [k: in. wall.. ft-
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<br /> ft size r y°a j
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<br /> E !9) WELL SEAL _ f
<br /> f - ,�'f .\ aa:.1„flcl,rit. 44—k.
<br /> LLas-suA sauger.;aml nnrv,der]- �']•�
<br />� \Lrem strata;cealnl.:,eainst t+rrtlneirm? ]"en•:�- \n ❑ Intrn'al ft.
<br /> _ .,fork Owl 1J Cmnnletcd .�-l9 r
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<br /> 110) WATER-LEVELS : I WELL DRILLERS STATE. \T �
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<br /> i.el rhe err n frac rn the Lrsr,,M mp
<br /> an.nrrrds!. nnr! Ix Nr{
<br /> -�ands°+•]nrl after rl! c+.tnnM•t n ' --- - - ' -- �; _� t
<br /> !tl i+'WELL TESTS. t LL arf l7fif3er)
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<br /> \Cas rlrr�trir•Gr ma.ir!
<br /> - D FORM'-.',+as.+scaor,aoioiih oa
<br /> I N EDEb:USE NE%T!,¢�NSECUTIVELY NJMBERE I
<br /> "6Y1R 1B9 •q[v.a v-. iF ADia l71 NA4 SRAG % _ -
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