Laserfiche WebLink
' ORIGINAL srATE OF CAW FORMA DO not flu in <br /> THE RESOURCES AGENCY <br /> IlNa. 053739 <br /> He with DWR DEPARTMENT OF WATER RESOURCES <br /> .a��fnteor u WATER WELY, D11I,�.T'RS REPQRT State wen rl <br /> Dst ! <br /> r�9-b9 �..• �v� Other�VeII 1\0 <br /> (1) OWNER: 1`ma Nelson Read Mix & Concrete (12) WELL LOG. ��a aep02Z0 &Depth of.mpkted dL2ft <br /> P.O. Bax 545 from ft. to & Parmatmn (Dwcxiba by calor. character, sue or matexfal) <br /> Cur RI-pon,_ at. _ yd Tftsoil <br /> (2) LOCATION OF 'G,'VELL (see instructions) � 2 a <br />' Catxaly at3�oa( u pwaees wall 20 - 29 Blue, cla <br /> Nell address of different hum a 2-2 31 Biu and <br /> T—mv . - _naafiIt 31 52 Blue <br /> nrstaoce fmm-Ries,mads,rtau=].,frmces, 2059 Navy Dros 2 — 6d 1,Nj4ue 5 <br /> ama <br /> Atnekt-am bb 126 clay <br /> r se sant <br /> ve clay <br />' (3) TYPE or woRK aLnu <br /> Maw W.0 X Daapemms p c Y <br /> neeflmtnteKoa ❑ <br /> IleCflndfhamayl p <br />' flmiamdal Well 0 = <br /> I7estrncboa f� {Qeresiba 2 2 lue C <br /> Procedure. mabmflaLs 202 � lSand <br /> procedarrs in Item <br />' (4) PROPOSED 14 _ Bl d U <br /> P0263,\\�,, <br /> S <br /> 7odwtxraf Ix <br /> T Well J <br /> S ---� <br /> �daainp <br /> ,41 <br /> iVML LOCA'TI0h Sl=7= Other E3 <br /> (5) EQTUFZMNT (e) CRA AC=C. L7o .. <br /> nomry ❑ Revem �Fo <br /> Cabla 0 At, ❑ \ r of boss {� <br /> Other ❑ Bveket ❑ <br /> (7) CASING INSTALi130. (fi) El1FORA (JI�Ver <br /> Steolm Flab❑ 0 Type of pegz ar of — <br />' Pft m f ns W�1 ft - <br /> 0 2 1 1 <br />' (9) WELL SEAL.. �st <br /> Wm swfsce m=taxr seal pmvsded? Yes% N* E] If yon,m depth_ l0 — <br />' were atxuta wiled ogaimt palhamm? Yes❑ No G Intl._,� +►_ <br /> Method of www stn Completed _ 19 <br /> (10) 'WATER LEVELS WELL, DRILL.ER'S STATEMENT. <br /> Depth of out wator. if kms — � THIS well m r drilled under mu )Wudwtian a report fe tare to the bast of my <br />' Standmg level after wall cow knomledga and met <br /> -117 <br /> (11) WELL TESTSs <br /> was mall teat made? Y.M No ❑ If yes, by wham?g_ ennisI (well Unger) <br /> Type of lsat Finap n Hauer p Air lrft© NAME_Herml-ngs Bras,. Drilling Co._Tnc. -- <br />' Depth to avoUx at start of test—ft At and of iron u Pew firm.or conwntfanI (Typed or printed) <br /> 1" 8)+0 n flftEx -h ts wour loapa Ave-, <br /> analrsi+ made? 'Y'es 0 No if ym by uba. city 0 <br /> Ya elechio lag mode? 6-79 <br /> Yes Q No if atmch Caps to this report Lieexme oto of this mpo*f q" <br />' DWR 188 iRry 71a3 IF ADDITIONAL SPACE IS NEEDED USE NEXT CON5ECUTIVIELY NUMBERM FORM <br />