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ORIGINAL STATE OF CALIFORNIA � <br /> THE RESOURCES AGENCY <br /> t��+ <br /> File with ®1d'1R N�®.VV1 91.9 <br /> DEPARTMENT OF'WAT£R RESOURCES <br /> voice of Intent No WATER r* <br /> WELL DRILLERS REPORT State Nveli No. <br /> Permit No.or Data /16'Com`',.� .-o t �Othaz Well 1� <br /> ( OWNER: Nye l-`i< ' V (12) WELL LOG: Total deptl,22-6.Depth of completed we 112205t. <br /> Addres, 1�fc from to ft. Formation (Describe by color, character, size or material) <br /> City r ip - <br /> (2) LOCATION OF WALL (s,,instructions): <br /> County Ownei s Kell. umber - t <br /> Well add if different from abovetra.� y QLA� Y - <br /> Townshi o <br /> IA-6.9Q (i Sectio <br /> �4 <br /> Distance from cities,roads,r.+ilroa.ds,fences,etc <br /> a <br /> (3) TYPE OF WORK: <br /> Iew W-11 Dcoperrinp❑ <br /> Reconstruction 0 - x I < <br /> Reconditioning O <br /> HorizontaI Well ❑ - / _ , <br /> Destruction O (Describe - <br /> destruction mnteriak g , v <br /> procedures fa Ilam )2 - <br /> (4) PROPOSED G <br /> Domestic 1 j <br /> Irrigatian * C A- U <br /> Indushinl ❑ `a . <br /> \�tWell <br /> 0 ^'^ <br /> nag- <br /> tcipa <br /> Mnn <br /> WELL LOCATION SKETCH Other !1 ❑ l <br /> (5) EQUIPMENT., (8) GRA PACKt ..- <br /> Rotary 0 Reverse ❑ ❑ No Siz <br /> Cable Air 0 l i ter of bo <br /> Other ❑ Buaket E] Vra <br /> (7) CASING INSTALLED (8} 'EItFO1L1fIY 'Sr <br /> Steel Ly, Plastic ❑ C r{c t Type of pe n o slae of scree From To Dia. ;e.dr F � To <br /> ft. f in. Wall ft. <br /> (9) WELL SEALS r <br /> Was sudnco sanitary soasl provided? Yesg_ No ❑ U yes,to depth�ft. - <br /> Wore strata scaled attaint pollution? Yes ❑ No D IntervnL ft- <br /> 3fethod of scalingWork atarte 19 complet _ 9 <br /> (10) WATER LEVELS: 4 tt WELL DRILL ER'S STATEMENT. <br /> Depth of first water. If kaon- i---ft This well was drilled under my jurisdiction and that report is true to the best of mJ <br /> Standing iovel after well comple-- it knowledge aq4 belief. <br /> (11) WELL TESTS: SIC` <br /> Was well test made? Yes I] No C] if yes, by whom? (NNe ' sillar <br /> Type of test Pump Q &ar7er ] Air rift❑ �7Alvf, <br /> 1t <br /> Depth to water at start of test ft. At end of test (re. t or tion) ( yped or printed) <br /> D(scharge _eat/mfg after hours Water temperate Addzes <br /> tMl analysis made? Yes ❑ No❑ If yes, by whom? City /, C-techie log made? Yes 0 No❑ If yes,attach copy to this report L:ccrrse No. 0 3..�ate of this report�•� <br /> IFWR- <br /> 188 (RSV.7.791 IF ADDITIONAL SPACE 1S NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM .sseie gso-r7ssom DUAPQr a9P <br />