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r r <br /> u SrAM OF GAUPORNtA <br /> ORIGINAL Twe AHWURCSS AQUNGY Do not jilt fn <br /> File with t3W/R 09PART MF-NT GTP WATER R SOURCSS 253283��G <br /> t WATER WELL DRILLERS REPORT N4, <br /> ORS �a��� ' <br /> i Il lCe of Intent[,In.? Sime We!1 due. <br /> a1 Permit w to Date - ---- - Other Well Na,�0nr - <br /> Nest. � rr4 -pa d PPF-) .l (12) WELL LOO, T'atai depth 115^it Completeddegth (t. <br /> # Address <br /> from Et. to [L Formation(Desscrlba by color character,sire ret material) <br /> cat., �T"4^/ --- - ------ -- xw -- <br /> r ,ra, <br /> (S) LOC-+ATI/OrN OF WELL(Sea instructions) — heti � ° 1 <br /> Omzdy- [Y2t1 .,/r�� /�Oweter's Well plumber 1 k ~ Iti Q-if' P 51 <br /> t <br /> Well address if daerent rain oboes - `3 <br /> Taivr+sbAp Itartga #/'�- Section 2- Cot S1 <br /> Instance from cores,read%railroads,fences.etr, - �� V'AI % C <br /> 4>1 tiC? N - !V ctv -- <br /> r <br /> r <br /> j (4) TYPE OF WORK <br /> N ~ New WA -Er Deepen[ug ❑ <br /> t <br /> } Recurutruchan 0 <br /> �J 'Recondt#aning ❑ <br /> Horizoatal Wall { <br /> Destruction 0 (Damribe <br /> dmuUtt[on materials and pro- <br /> � cedures in Ram.12) <br /> I (4) PROPOSED Us <br /> Imigatinn <br /> Industrial [] <br /> ry'v 'f,est Well ❑ <br /> Nctly <br /> � tr� �t�t� r er <br /> WML.LOCA='N STATCN ibe} [ F <br /> (5)EQMPMEN7` 8 C.RAV Cit <br /> Rotary © Reverse © NZ <br /> (5! `(.able ❑ As ❑ of born <br /> oth" 4a-� R.0 d Frena s A <br /> )CASING INSTALLED (8) YE tt <br /> r Steal ❑ Ptsate d C naruzeaf Q <br /> From D Gage or t <br /> stee ft f Wal( t sue <br /> Fx ( <br /> 5J6 40 <br /> 1 `^ <br /> (9) WELL SEAT. , + <br /> �—. Wassvaface sanitary seal pmvidaa? Yes RC1- No ❑ If ye;Lodepth <br /> 4Ycnestralascaiedagptnstpa$utlen? Yes ❑ No Et' IuteSval <br /> Wags <br /> ��++ 8 �� �[�� Work started i8 Cam ted 19 E <br /> Wtr�l (10) WATER LEVELS � WELL DRILLEWS STATEMENT <br /> Aeplha[[ilstwater tiknawn [t <br /> htet6oi [r (� Thu ws[l w at drdw under m ltrrtsrficeton and this repot! Is eros in t <br /> () S7aRtlanblEYeta[LCr WCIICWOPIandq [ti best of my krrarals a arsd 13e <br /> Depthi (21) WELL TESTS mgned � <br /> WW vmH eest usade? Yes© Nue' If yes;by whom? W 1 <br /> su'diq �iiteigeoEtat Pomp❑ R96r 0 Airlift Q NAME �G rV •tf <br /> 1— 1 — to waeeratstarrof test It At and of test ft Pexsaq ilrm ar cosporatian)(lypcdarprYn►od} <br /> aswe� 6asge gaifueutstften hoop Watrutemperatum hddsssss <br /> xo[ C6ertteaiaaalysismada? Yes Q No Er Tfyes,bywhom? City s zsr <br /> hth t� W.,1.11.lag raae[er YC7 ❑ No I� if �i�arh to tbts rayni Lim—Na Date of tl]d5 T t <br /> IF A100MONAL SPACE'is NEWMED. US@ NWM CC N=CUTIVOLY N1Ub"9EFM*FORM f <br />