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YMPLICATE OTATIf.or CALIFORNIA • DO not fin <br /> ®Wr7@r'A Copy i THE RE�J.OUNCES AGENCY t1� /, 7 <br /> f <br /> DEPARTMENT@F WATER RESOURCE5 No. 0613 G <br /> Nntice nl Intent N,,- _/ WATER WELIL DRILLERS REPORT slide Well Nn._..- <br /> Lucn1 YnmN Nn.er Due 0A.,Well <br /> (1) OWNER: Nnm• C91,It{. 401V j!.-Y_ f'A C_-_. fJ _-_. (12) WELL LOG; -rnot rmd, y+Z R. Devlh ui wnnpletwl venIZ-_n. <br /> AJdf.wlfd <br /> TAI. dm,� A?'? <br /> . _�y(,,, <br /> i fnnn il. b: h. In.rmu,hm (Do...be D unhm 'Annmu4 .&q ur mntemal) <br /> - ., `/J P•P•w• -' �./r. _�In• tow d0/4 <br /> � r'f_ .-,.yip-----f--- ..�---,�_,._._.� <br /> (2) L(`��(AA1r,�J7�k� OF WELL (Srmfnytrucriunr): <br /> Cu.nrye.lti}C.al��aJ.�L..-_-_._Owiefe WrP NnmisAr......_�..-._.T_..-.. _.. _— <br /> Wsdl.JJrrxr N A1Pe.em fmm nbnw _ .— <br /> Tnn,mbinid �D Brntlr___�_�.1...�-Saclhm_•._-. ` —_... ^^ .___ q-+/? - <br /> D+ xt c Inum till", ak nolmadE/eric�t r .17�✓. i.I11..3P.fL ii — ._ <br /> has f o f,f l�wY ` �A3f ta�Lsr1�--� <br /> ARM oKN[4rueqr.� rr <br /> /vo (.3) TYPE OF N'O Kr --- <br /> New VeOl* t.hnwlueq ❑ <br /> IlnunmlltinninA C7 <br /> � Ilnri'nmbll Wdl I <br /> \ lv <br /> ❑ .;T,, ..\', sem../ <br /> Tl <br /> 11 <br /> d-I wjkm mmninh <br /> (4) PROPOSED�1 - :\ <br /> ..t.v�1..• <br /> A <br /> if fe Indualrtnl � E3❑ <br /> WELL LOCATION SKVTOI Olher <br /> (n) 1SQVIFMENTr (d) CBA, MACK <br /> Itntftry C) <br /> CchIe ❑ AU ❑< ter of hmo-�P. <br /> . - <br /> D.her O B'nko G id hvm.__ <br /> (7) CA&ING INSTALLEDfB)`'VGNfiO�B;AY1r1NSr <br /> 810A 13 111.rrle4. Ci o t 'IYne of porrq?allq`r...n1ee_J aertr-.n�'} <br /> From Td DIN. (11;4 r F tx ., =/� <br /> f(. f (n. 'Wulf <br /> (9) WELL SEAL, <br /> Wes.arfnee ranitnM rent pmvlded? Y"`0 Nn ❑ If YnA N deprtr_Q <br /> Wein strata reeled afalnst pnir ion? !(or ❑ No I-) Infew:d_.........,:_IL <br /> Method of ,,Olin r ._._.... •- -j•-•. tVnrk unrfn „_IPPR,__ COMPIMI___.,. _....19 .. _ <br /> (10) WATER LEVELS, WELL DRILLER'S STATEMENT: <br /> DepW of 11"t water, If knoWls_.--.--_—_.-.---__/--.y-,t. 'Thfr welt war droWd nnder mp 1 is d.1 nfere i. 'ma, Po Jrc tna of ma <br /> 9wndlr4a feat arts, Wall enmpkil /1_ AnnmimlNe nnfl ` <br /> (I,1) WELL. TESTSt - <br /> Wnr well test made? Yn No II (Wxl pr+licr) <br /> ❑ ❑ ret by vvh•mrY_......—_.-_=_ e/) _ <br /> Trlw nt tea Pump D nnPer � Air Pft❑ NAME:_-.I_L^- !r _r(r[ L NIr ....... <br /> Depth In wntef At $felt of les At and of rest-_- ?tti'at Omr,m en rnW (TYpnl cr print. <br /> Difrfinrgn_—__—yn1! Addmis <br /> flhmdmd Alla Ode? Ye, U No ❑ if yn, by wd.�m°_-_..._.�-. <br /> '.V-W alectrie hp made? Yet N It cx,snack u rn drix m art Lrce^an Nn.-. ?e�`!�� Dare of rhh euynr- _ <br /> ❑ a Q T mY v Meta,. <br /> 100 (REV.7.78) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUhIBERED FORM <br />