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v <br /> Uze 4a comply With STATE OF CALIFORNIA <br /> tee <br /> THE RESOURCES AGENCY DO not rill in <br /> Bee€ :frel'sents DEPARTMENT OF WATER RESOURCES No, 083148 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT <br /> Local Permit No. or Date ')— State Well No, <br /> Other Well No <br /> (1) OWNER: Name Erob YE'Lada <br /> Address 1 A .i• 2 r�Cy .. � (12) WELL LOG: Total ae m � �Vf <br /> P �- t.Depth of completed well-96 <br /> ft. <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> Cit �ra.Cy' a . <br /> yip 0 - 1'0 ;soil <br /> (2) LQC, IS)&q WELL (Sieinstructions): 6 Blue Cly <br /> County Ct Zr Od II Il Owner's Well Number 6 - 9 rW <br /> Well address if different from above 9 - 15 "la . <br /> Township Range Sectio n u \ I - J' <br /> Distance from cities, roads, railroads, fences etc. ss• r"C'Jr 1 v •' -T 5 )r= ��'-Lay s n S G ;Fs <br /> - <br /> just <br /> just north oOr^ntTine Cana , :m _ <br /> Test of Tr4c i?1vU& 6 _ <br /> 60 - Sand <br /> (3) TYPE OF WORK: 1 CTa --- .L <br /> New Well X Deepening ❑ 1 0J d <br /> 144- <br /> V+ j <br /> Reconstruction ❑ 90 _ 22 <br /> Reconditioning ❑ 22 - '12 <br /> a :q <br /> Horizontal Well ❑ _ 12 y -AI <br /> Destruction ❑ (Describe - c <br /> destruction materials grjd <br /> Procedures in Item L`' - <br /> (4) PROPOSED 1 <br /> Domestic _ <br /> Irrigatinn� <br /> Industrial ��� ❑ CJ <br /> Test Well ��ff ❑ ��- N <br /> Municipal - � �� 0 <br /> WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (6) GRAPACK: Rc _ <br /> WIS <br /> Rotary Reverse ❑ IV No'❑ Siz - <br /> Cahle ❑ Air ❑ i m er of bare B <br /> Other El Bucket ❑ mm t - <br /> (7) CASING INSTALLED(R (8) PERFORA S: <br /> Steel EJ plastic C T tC Type of(Cpe, n or zebf scree - <br /> Front Tit Dia. G r F To yv <br /> ft. fp in. Wall f . ft. S - <br /> 0 160 9 e een - <br /> (9) WELL SEAL: <br /> Was surface sanitary seaI pmvided? Yes No ❑ If yes, to depth_5O_ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval k. - <br /> Method of sealing Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if knowR. This well was drilled under <br /> Standing level after well completio 8 ft. knowledge and bella). my jurisdiction and this report is tore to the ben of my <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No X If yes, bs ,,hom2 (Well Driller) - <br /> Type of test Pump E] Bailer ❑ Air lift ❑ NAME rFpnni n S Rrne i ri l l i nC' (�0-iTnr_ <br /> Depth to .cater at start of tes ft. At end of test ft (Person, firm, or corporation) (Typed or punted) <br /> Dischergo oe]/min after -X—hours Water temperature Address 31r' 5 Del n ndl e lyp <br /> Chemical analysis made? Yes ❑ No l6 If yes, by whom?-- ,pita �,tj2� Zip 95n pT6 <br /> Was electme log made? Yes ❑ No If yes, attach espy to th s report; License No. Date of this report 1����ClQ <br /> DWR Ing (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br />