Laserfiche WebLink
ST.-TE Of CALIFORNIA <br /> • THE PESOURCES AGENCY }} <br /> ORIGINAL Do not fill in' <br /> File.. with DWR DFSPARTMEi,.,' OF WATER RESOURCES <br /> WATER WELL DRILLERS 11EPORT N0. 257288 <br /> f, b <br /> Notice of Intent No. . State Well Na i rY <br /> Local Permit No.or Date g y- ZT-7(f Other Well No. <br /> (1) OWNER: NamerNEV (7—_55:4 INCA (12) WELL LOG: Total depth-ZL2 ft.CompleteddepthZ3_Oft` "14-A <br /> Address24(,o eRM ,'No P-4MON ._ ` �> <br /> from ft to ft Formation(Inscribe by color,charaNer,size tsr tnateriall, °-'` ' <br /> C;cy54nl 4M __ZIPq4583 p - Z Set., �w �at,.e ✓tw <br /> (2) LOCAT;O OF WELL(See irutructicns): L - <br /> County s`9� �Q 4 i n/ Owners t VeH Number w - S i tAA a iu to 9q.. t ✓ObU. . <br /> �'I? 3s<*S r)A ,Z). A,74 Ct} S - i'a2 K w a I w„ Q V 4( ✓OW M <br /> Wel!address if different from abov <br /> Township TZ S Range 6 _.Sec-ion 2 - <br /> Distance from citJes roads railron fen�a et�/t 4 $G °`1 ZS — L6` S�t` roW K <br /> S�O� 3tcrl' <br /> t <br /> _ xear� <br /> 3) TYPE OF WORK: <br /> r 1EE47e4 <br /> New Well X. Dkepening ❑ — 5+ <br /> ..Y rrf5! <br /> Reconstruction ❑ — R' W <br /> 7-VVA Reconditioning ❑ <br /> J <br /> L. Horizontal Well ❑ — fy ' <br /> E \ Destruction ❑ (Describe <br /> H I tq&L destmction m2teria13 and pro- <br /> e rv,• ; ' <br /> cedurrs in Item 12) o $ <br /> (4) PROPOSED US <br /> /l Domestic _ +K•"i}A}sti' «M <br /> 3 Irrigation <br /> Industrial ❑ y;..s4Z$.,, dqr` <br /> Test Well O ❑ tw rY�ar f <br /> u't• _ Munici Ier <br /> ❑ 0 ak3r.`;: f t <br /> A 37 t4 <br /> WELL LOCATION SLSTCH be) <br /> t (S)EQUIPMENT CRAY CL• <br /> x� :Rotary•fT •^r Reverse. ❑ S No I - - ,.•T r rxui.'" .,,, <br /> .Cibfe ❑ Air: ❑ y `etc bom i _ 4 tvwv tdfyr <br /> {ACI�7i►20ther 'r Buck llelrpd tom 2 <br /> (7)CASING INSTALLED_ i. �8) PEn efgal <br /> Surd Q Platte r of Nat or ria of _ .. •::UF n•':fi6!G}) <br /> From T i Cage or t <br /> fC Il i Wall. t size <br /> 3' wctU 0.020 �srir.rx?itid <br /> (9) WELL SEAL Z,S <br /> WaawrfamraN f'al edl Yes No — <br /> Lary' provid X ❑ It yes to depth ftF:, r,; <br /> Wetestntaaraledrrpinst Ilutbn? Ya C No Interval Ft - .-tc 'r '� 't j <br /> M@thodataeallrt`p� '�t C`' �"' t�tA Work started O O 19 Com leted <br /> 7(10) WATER LEVELS: WELL DRILLERS STATEMENT- <br /> it <br /> TATEMENT y } <br /> Depth of tlrrt water.If known ft This well uns drilled under m' jurisdiction.and this is erre(9 t E Y <br /> Standir,%levet after wen emnoctlon 6 IL best of my knowhedge and bell@, <br /> (11) WELL T'cSTS: �[ -!G. Signed <br /> Was v,sll tat mad+? Yes& No❑ if yes by horn? F1t-� t� (We Drl kr) T <br /> Typottat Pam}j Bailer y Airk/t L NAME SPEGrIQtll ) �C GO�r}7'/p�f 611/x• %. S: <br /> Depth to w at R �e}��ts?�1 ZSlft At end of test_,1,70_It p t R or f� �^)Typed wgCoted) f' <br /> DUehar;e�{Qlin aft r hours Water mpentur• Address Z 8 Z �+ S1 'r <br /> Chemical snalytis made? Yea No❑ If yes by whom? � � G•. City STf�K TO � ZIP Z <br /> Wu ekvtrle log mid@ Yes❑ No X If yes attu:h coov to Chit matt License Na Z Z Dote of this r rt 1 O a ' <br /> 07-A OrTIONAL SPACE IS NCEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> t7WR 1QA 1/1uM. 11-@@1 -N.N7S! . <br /> A.. <br /> 5 -'t - 7�{Wistiw'Ji�M�"^"��'-'• Rama- <br /> Zi. <br /> aaa ; r�'j <br />