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STATE OF CALIFORNIA
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<br /> 1 CL ICS iC+E ; €'f s JFFnq
<br /> THE RESOURCES AGENCY. DO not fillin
<br />+ - DEPARTMENT OF WATER RESOURCES No. 083148
<br /> Notre of]ntrne Nn.. —__-. r
<br /> WATER WELL DRILLE$S R
<br /> E
<br /> PORT
<br /> 1 oI No. or
<br /> State
<br /> Well VNn,.
<br /> _
<br /> Othl.r lel
<br /> OWNEII: Nn, iob Y. :mnd (12) WELL Total el f� elb of cplr -r—l.._,,all
<br /> -_--9---`6—f
<br /> 6tilress_ (nno f. to fl Fonnannn b) vol., ahmrize. x -1 ca __ -
<br /> tem eriary
<br /> (2) LQQ� Jjy&fOgjjyBII. nl
<br /> (Sceinttltloos)o / - 6 Blue L`1H7T
<br /> Cot vrl ,_ __Ota mrs \\ell Number ) r 1'1O
<br /> R 11 idd e s if diffewat frons
<br /> S tic
<br /> 'DisNo'c Iona rhes, roal ulnas,foncoe etr._ • rl I 'C �° ) •\f(1 •r - J -
<br /> dust north of..Gr nt).ine t .Iri T*171 i -
<br /> _ 'let of '.r .r.� 56 - �i�. ^lay -
<br /> -- 60
<br /> (3) TYPE
<br /> ;;t{i[OF WORK: . . 2 � (,j , a
<br /> Ne,a Well IN ❑ Q:^ \ O 1;aU
<br /> IlecnustrnUfnn p yO _ 22 !
<br /> . ". Rccnudrh°nfng [.] •sl(< 2 i y,y.�£j it
<br /> Harlkoatal W01 ❑ \ - ,'�,,.. YZ y •�
<br /> Des lnmt o, ❑ (Desoribc \\ `••.' - \\\�\vt ((`\+
<br /> lcslrvel m n rte ials
<br />'- (9)`PROPOSED UISW
<br /> . Irrigali .. y ., ❑l \tst Illl
<br /> ad, +. U . . 1
<br /> p
<br /> WELL. LOCATION SKI?TCIi +�`e,.:' Other �{ ❑
<br /> (S) IiQUlI'TIIiNT: (G) GRA VI PACK:
<br /> /.
<br /> Rotaq• $everac ❑ 1(e\( To ❑ S :C\\ .`q
<br /> Grbic ❑ .4ir ❑ dieter f Iwre_,__—
<br /> Other - ❑ lluekel ❑ bye td l m {Z.._tn�.6- (n.r'\ - . .
<br /> (i) CASING INSTAL1.73D.t' �`�. (S) PR HFOIlA�9`'[f) S: \ ��\ -
<br /> Smel ❑ i'Itstic Glt r`ti,(9. T' of ho: (T,r�ta�ien rorbf cb(scree '� \ -
<br /> Y
<br /> hmm 1� _�•. Di T4 Glge�r )rrtD� \J;i •1Z> ,/j ), `:> s _ -
<br /> ft.
<br /> ft,',+ `I m. Wall fE:, fC: zz
<br /> p \. 1 O �\ \sic een
<br /> % _
<br /> (0) WELI, SEAL
<br /> Was surface snnitmT seat provided? Yes No p If yea, 1 dcpllr_�._fl.
<br /> \Nem strata scaled against pollution? Yrs p No 11
<br /> Mt dmd of staling ._ W k t, ted: `-J aj( . 1f1 C,...pletcrL._.
<br /> (.10) WATER LEVELS WELL I DRILII RS STATEMENT:
<br /> Ocplh of Srsl a,alet, if L < ,m: ..... pp ft. 'Th, u,01 rets d II d onrlcr mot mLnsrctroa rnd IN, repo r s nie. to th, best of .1, L
<br /> Slm,dfng level after well co - -
<br /> mpletion—.___ __S�.__._ `fl. Irnmoledge oal.belie). .
<br /> (11) WELL TESTS: - St(:.r•,u----'._-.— --_--
<br /> Was well test n,ade? Yes rl Nn I If ley, by-edumr? _, - - (Well Dolle:)
<br /> Type of tttr rmm, n„perp Ai, lift ❑ NAM1tE__ Cil 11 '^ br9anc 1'ri } lin y
<br /> Dq>t, to ,rater at start of test_._- Q. At end of test-._..__..._.._fl' (Person,.lion,or topnrrnbnn) ('Typed m Panted)
<br /> EAsd,argt___gnl/nun �_r
<br /> (lenrad m,alysk o's,10 Yet ❑ Nn � If les by M... "i`lOf.L,.�°s het
<br /> W d"tric Ing amine? Yes ❑ Nn yy If >c , altar' rUp> to Ibis capon -f.icc,sc N._�12(1f __Date of Ihu rel>nrt _�❑.^E.SJ.Q__.
<br /> DWR 188 IREV 7.70) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
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