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I ORIGINAL STATE OF CALIFORNIA Do nQt ftlt in <br /> THV- RESOURCES AGENCY <br /> We with DWR pEPARTMENT OF WATER RESOURCES No, 197608 <br /> N,okib Intent No WATER WELL DRILLERS REPORT state ,,,ell lfa0 Va DI 0 <br /> Local Permit No or Date Other Well No <br /> (I) OWNER Naroo C (I2) WELL LOC Total dep l` tr'Dv��FleF�3 t¢c�wa ��ft <br /> A,111M �714- �. a A+ from ft to ft Formation (Desenbe by color character size or material) <br /> Guy <br /> !!SM. lt.r r lz t---, Lip <br /> (2) LC ATIQN OF ELL (See Instntctlons} _ _ <br /> County t,. ? l E Owner's Well Number <br /> ti L11 address If different from above ff_-__ Sw <br /> Township— _19 Range `i?P— <br /> Distance froth cities,roads,xnikoadr,fences,Ole <br /> rU <br /> (3) TYPE OF WORK F <br /> New Well W Deepearng 0 ' <br /> /' 1 <br /> Reconstruction. ❑ A J3D <br /> X <br /> Reconditioning [] — ,c 0 I <br /> G11 Horizontal Well ❑ ,�, J <br /> Destruction Q (Desenbe <br /> destruction materials i y <br /> "A <br /> procedures =Item = 1 <br /> ( sC/ CtIVV (4) I>ROPOSFD <br /> } r Domestic <br /> ! y <br /> Lod al Q�!t/ L !�F—�� IrriHaaon 0 <br /> 7ndustnal Q \/ <br /> T 9 Well Q — <br /> Stoc \ <br /> M I <br /> uniolp —/1 <br /> t <br /> WELL LOCATION SKETCH <br /> L` Pt4jT*eF tRtr v - <br /> (S) EQUIPMENTi (a) CRAYACC <br /> Rotary ❑ Reverse ❑ No sue <br /> Cable Air ❑ eter of bare <br />' s OiherBucket ❑ kO fFom <br /> r <br /> TIO CASING INSTA: (8)-kRFoR <br /> Plastic{ COtType of pe `� u Otza of screZeSteel t <br /> _I�t <br /> I ' <br /> From To D,a Ge r Frm?\ f° sig <br /> ft ft in Wall ft rs <br /> ti l f. <br /> ' (s) WELL SEAL, ' <br /> r <br /> Was surface sanitary seal provided? Yes x No (3 If yes, to dep — Qua ( <br /> r Were strata sealed agar t pulluticu� Yes a No E) Iaterva! ft r^ <br /> ` Motbod of realm Work startc 14 <br /> (10) WATER LEVELS WELL DRTLLER'S S'T'ATEMENT <br /> Depth of first water, if known w _ - ft This wets as drfifed under my ti diclfon and this report ii true to the best of my <br /> 'v Standing level after well compleboiL.—„� rr knawfedge n ffa/ <br /> (11) WELL TES'T'S � SIGNED <br /> Was well test made? Yes No d If yes by whom? (R'ei1 rtllar) <br /> Fype of test Pump Bailer ❑ Air lift ❑ NAME U, <br /> F]epth to water at start of test ft At and of tcsL --fit (Ferro firm,orcoxpirr3tinn . T ped or?Rated} <br /> _ barge ._Meal/min after hours Water to ImI11porfa�t�ur Address C~ �7 <br /> ^' hcmxcal aaoiysm made? YesIQ No Q If yep, by whom? CC'IZr�1 41'L` City ip <br /> Was electric lug made? Yes Q No If yes attach COPY to this report License NO Date of this repo <br /> rt <br /> ' E)WR Ise iREv 77ey IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUM8F—FtEf?FORM <br /> 'f <br />