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'RIPLICAT! )wnor's C*py aM of Intent No.— '___ ___ -__ . -sal Permit No. or Date-M--l-S7 ) OWNER: STATE OF CALIFORNIA /)I) Hili h(l tot THE RESOURCES AGENCY DEPARTMENT OF WATER RESOURCES `�.) HLALIF)No. 168966 WATER WELL DRILLERS I RI RT: i ��FS�'•'�,�I. we No -- --- — Other Well No. ,• 'grapy, Wife 95375 LOCATION OF WELL (See instnictions): aunty =-plin O ner's W 11 Nu be )r �l+t 1 cxl, 6; aa' wn.hip 'hl"AC=V Ilrnl{r_ __ _Section__ :tante (mm cities, roads, railroads, femes, etc---- IF (12) WELL LOC: Total depth,U_.Jt. Depth of completed well -160 -ft. from from ft. to ft. Fortnatlrm ( Describe by eobre character, size or material) 0 - 3 Mo soil, clay -4 - G Grand 10 13L'IlwlltslnY 10 - 24 Grav�a]:\�, c1aY strE�eko 24 - 44 Gravel 44 95 131.Y'>' in claY ()5 - 97 C,7'. ml, -9) WELL SEALi - -- Cas surface sanitary wal provided? Yes]Q No ❑ If ye,, to depth_t� ._ft. EVere strata sealed against pollution? }Yes No ❑ Interval __.fit. f/ethood of sealing_ `w�"ute --- Work started 19 Completed_--l`{.------ If)) WATER LEVELS: WELL DRILLER'S STATEMENT: —)epth of first walnr. If known -- —k This well toxo drilled under my lurisdirtioe and this report IN mo to the hest of nolo tooling level after well L onpletioknowledur and heliel 11) WELL TESTSi SIGNED o�G z n .4—_--- /uwell test made? Yes ❑ No ❑ If yes, by whnnu? _ � ( Well Driller) 'y)pe of teaC1L� t Pump ❑ Railer ❑ Air lift NAME jjKtAW Drult'm (�ba e I Ce epth to water at start orf test h. At end of test ---ft (Peron, (irm��,++or��corporation) (Typed or printed) >Ischarge rap/min after hour$ Water tem;oenture Address 31 -- 0 .Oi h11f.lI'L — 3%rmical analysis made? Yes ❑ No ❑ If yea, by whore? —_ City riLTlerk (~11��a _._2ip_953Ei(l swVre electric Ing made? Yea ❑ No ❑ If yea, attach copy to this report I License No, 32122-? Date of this report—._4,_.1. 3WR tee (Rev, Ir -re) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM lxgw gla- 7r 104 11o" - 107 , C;rav,31 11 (.1 j TYPE or «'t1F!C : New Well JP Deepening ❑ Reconstruction ❑ Reconditioning ❑ Horizontal Well ❑ Destruction ❑ (Describe destruction materials pna-enures In Item (4) PROPOSED I)omr.tic rditatiori Teit Well ❑ Stock 10 Municlp�l� ❑ Other i ❑ 107 , ; " t Clal - 1123 (fie- 123 — {t Brie.-, .:la _'1.36 - 45 ' �/ *� — 5Fj . (, &%tj & clay stmaks 217-DraAl C.LaY'� \ - — '•J — .\ WELL LOCATION SKETCH 41 EQUITMENT1 otary Xx ahle ❑ Cher ❑ Reverse ❑ Air ❑ ` Bucket ❑ (H) CRAVRL FACKI lee Of No Size Ytl 0hspeter of hore_,z_.'/� ? '—Gr$ - Pa'ir`ed Boom 1_Y]L_te�T F St�[�• — — — . -7) CASING INSTALLED:(, ,rel ❑ Plastic :v Colrt)Rtr iL'} (III PERFORATIONS: Type of per4uetlow or size of screen - — — Fmnl To ftk(\ Dia. Gagor - in. WRII From To Slot ft. ft ft. -9) WELL SEALi - -- Cas surface sanitary wal provided? Yes]Q No ❑ If ye,, to depth_t� ._ft. EVere strata sealed against pollution? }Yes No ❑ Interval __.fit. f/ethood of sealing_ `w�"ute --- Work started 19 Completed_--l`{.------ If)) WATER LEVELS: WELL DRILLER'S STATEMENT: —)epth of first walnr. If known -- —k This well toxo drilled under my lurisdirtioe and this report IN mo to the hest of nolo tooling level after well L onpletioknowledur and heliel 11) WELL TESTSi SIGNED o�G z n .4—_--- /uwell test made? Yes ❑ No ❑ If yes, by whnnu? _ � ( Well Driller) 'y)pe of teaC1L� t Pump ❑ Railer ❑ Air lift NAME jjKtAW Drult'm (�ba e I Ce epth to water at start orf test h. At end of test ---ft (Peron, (irm��,++or��corporation) (Typed or printed) >Ischarge rap/min after hour$ Water tem;oenture Address 31 -- 0 .Oi h11f.lI'L — 3%rmical analysis made? Yes ❑ No ❑ If yea, by whore? —_ City riLTlerk (~11��a _._2ip_953Ei(l swVre electric Ing made? Yea ❑ No ❑ If yea, attach copy to this report I License No, 32122-? Date of this report—._4,_.1. 3WR tee (Rev, Ir -re) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM