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, L <br /> ORIGINAL r STATE OF CALRFORlFtA t Do wt fim <br /> THE RESOURCES AGENCY 11�. 185788 <br /> � <br /> 4wide�fith DWR DEPARTMENT OF WATER RESOURCES <br /> +f ba mt x WATER WELL DRILLERS REPORT sista weRl Hfl <br /> s,mit Na or I)a d Other VYell No I � — �• <br /> (I) UWNERi N 0 j 12 WLLL LOG: <br /> Tatnl dept,I]epW of completed aral�.jt, <br /> Addrgaits [ra x■It to & Faamatton (Describe by aolor, ebaraeter, size or matonal <br /> 0-14 <br /> City <br /> (2) N OF VVELL (Sea instructlaw) <br /> CcmvAy Owner's Well Nurn <br /> wolf swidsess if diffrrasrt from alrov A <br /> � • <br /> Township eatlo ; <br /> ,Dhbkmae from 4103, mads Fences, <br /> ' (3) TYPE OF WORIf <br /> r New Weux Deep"ang❑ <br /> Iieaonatsuctim ❑ — �* �.�, <br /> ReeaaditUming 0 — <br /> Honwatal Won <br /> estruedou 0 (Vascribe <br /> d <br /> estmcttaa matorlwla d <br /> plecedures in Item <br /> (4) �AOPOSED� Q <br /> staa)� � •�Ul <br /> NAVY <br /> VVELL LOCA'T'ION 5=TCH <br /> {5) 1SQUIP143I3PTlx (s) PACK. <br /> Rotary ❑ Iteverao {] No .1Z <br /> Cable ❑ Ase ❑ �, - r of twr ' �� t' <br /> a � <br /> OtherB"Act f3 � .rrmm -� •' <br /> �4 <br /> (1) CASING I ALLSD(- %l (f)}'rzWoRkilo}�S11 s � <br /> Steel Q Pladio Cret@ Type of pea o sixe of 3srecu' t, NRO <br /> Fkoul Tis Dla, ce or P To <br /> EL >in well ft ,t { <br /> v <br /> (9) `PVELL SEAL, <br /> Was surface sanitary aeon provided? Yes id' No O If yes, to depth fL -- <br /> Were strata seded aod-t p ltutlonP es MI. No E3 Interval���� <br /> U.0.4 of ae ar!{ ata g cumplat 8 <br /> (10) 'WATER LEVELS- WELL DRILLER'S STATEMENT <br /> Depth of fba water. if Tho youmea under my furftdkn tloand Chir report it rme to the best of mV <br /> stm!ym level Maar wolf comlpRalio f_ �,wsaledge <br /> (11) VJELL TESTSr 5tc. <br /> Was wall tact madei' Yes ❑ NOV If yes, by wba- (Well n f <br /> Type of test Pomp 0 BAi)er U Air hit 0 NAM <br /> Daytb to water at atilt of test _ At and of tesL-------;ft Perso J coryora ) (wy pr panted) <br /> l M— - *wmin after—_--boun Water tenl6em Address <br /> armlysis mad <br /> e4 Yes 0 No El If yes, by wbom7 C+IIY <br /> log mads? Yes No Q If yes,attach copy to this report IItcestsa N of this <br /> Uwlt las (sev 7-7ai IF ADDITIONAL SPACE IS HgEDED USE NEXT CONSECUTIVEI—Y NUMBERED FORM <br />