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i <br /> I <br /> QUADRUPUCATi <br /> Us*to comply with STAT[Or CALIFORNIA Uv not fell M <br /> localroquiromonts THE RZSOURCES AGE Y 'IG o,j 1979 <br /> 59632 DEPARTMENT OF WATER RESOURCES No. 052185 <br /> Nrtid�dt'^t�^t Ndr• 1 — WATER WELL DRILLERS $EP,OHT,Q'_)I I`, <br /> ,jj!rI%Yell No j I <br /> 1,,e&l Permit Nn.nr Dor )-EN- DIS <br /> f rl Other Well No. <br /> A UP 2S. a c o(1) 0%VI IWUr3ft— 12 WELL LOC: <br /> ``7/7,2�a`��—� ( � Totul depth--ft. Urpth of umtpletnl.,II —it. i <br /> Addms 7_ 4�!• A`��t from ft. to ft. 'nmr ..n (De., h calor, rhnmrter, •i a nr m.arrial) <br /> cit)• �iZ sip 7J 7 C3— i <br /> (2) L0S;Ajjl%A?fUjWLL <br /> C rant)_ <br /> Owner's Well Number a 1 I <br /> Nell address If d� v7 rasnl fes-andove_ 21: 25 Pin <br /> TuwnrhlP R■tdcr_ - .r« <br /> IL Py r i <br /> Dbtt�t•CAi`Lf1�ds�Vri�v'lr1�a�"��--tQa'�--- _ � ''� <br /> - i <br /> (3) TYPE OF WORK: t <br /> New- Well Ile-a•PeninC❑ <br /> ❑ vel_ <br /> li—nditiunin¢ " <br /> Ilori—rital\\'ell ❑ _ ,`R <br /> t Devtructinn ❑ (I)rwribe — 82 OtAy <br /> dolmetwon materials .( r�,i I <br /> Pnaedurez in It.... l_ — A Coarse 4 nd Kmvel l I <br /> 80 <br /> (4) PROPOSED 89 Sand ri <br /> D..'estir W20 <br /> la �An` la ers of f ne sand <br /> inicatinn� ❑ 0*"'C 'ind <br /> 293 etay <br /> ❑ and-sand ave layers <br /> ­ <br /> C) <br /> \\'ell (\� ❑ Y <br /> Tt - arse ears <br /> hluniciP — ay an layers grave <br /> WELL LOCATION SKETCH Other / ❑ _ - " -- <br /> (S) EQUIPMENTr (6)XPRA\' ACK, _ ve ' <br /> Rotary 1x Revere ❑ ❑ No Si (• L463 Clay <br /> (-able ❑ Air ❑ r of bo 27n Sund <br /> Other ❑ Bucket ❑ nrm b _ <br /> —_$ <br /> (7) CASING INSTALLED* <br /> (8) PERFOR u _ <br /> Sim❑ 1'lisaic� a. T)I of"'i ,rase,.f scdee•r(1 _ <br /> Fnnu To Dia. Ga !r Fro\ To309 Sand <br /> <f 1t1� 1 <br /> ft ft i 1 � A4Se� - <br /> 309 316 er nit a! <br /> clay <br /> 335 G4:9y <br /> (9) WELL SEAL: x \ 50 ;e i1i. <br /> Wm surtaae unitary seal Provided.' Yes❑ \o ;' II c .,to depth_ _It. �aJ <br /> -qgs or removing of! the He eal or <br /> Were strata sealed ■cu <br /> anQ�a,t Yr. ❑ No3 dImenvl— itLfwgui <br /> a <br /> Coug9eted _—_ <br /> (10) WATER LE\'ELS: WELL DR!LLER'S STA•rE\TENT: <br /> Depth of first water, if kmran It. IN, -11 dc^s tolled oruter nn, verlsdretion and thio rrlmn i. Inde to the 1—i m <br /> Standine level cher weB a.wupklum _It. krwru Ied,te and befiet. of <br /> (11) WELL TESTS: <br /> Was aril test made? Yes e .•.c It ,e.. by .6.m1 Pan"o Wel.1"biT,11 ng—lac.T)pt• f tot Pump ❑ Bailer❑ An Idt❑ <br /> \A\IE _ <br /> On" to nater at +ton ..t test _It. At end ,•I ""-ft 'nog,Y+�i@at dI10'Qpn O trJ) <br /> IN.charge--------+ral!miry altrr hour \Pater h.-I—dnnv__ Add— GakIJA.A*_�`�l; �1�7L1 <br /> Ch—wal analysis made! Yes C N„ C) 11 )rv, hr »h,an:+ "t –33-3114 —.13/l/79Js- --1 <br /> \Ca.eeatno k.e-Ir? Y_ ❑ No ^ 11%.-,. .otta,.h o-q.. b.rhos n-(.•n I.hen..•Xo_--,-- _Uate„I thio relw.rt____-- _ <br /> OWR tee tacv.7.76. IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />