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<br /> DUPLICATE WATER WELL DRILLERS REPORT . Do Not Fill Iii
<br /> Retain this copy (Se..tonrso7s,sono,7001.Boat,m.ttr C.d.)
<br /> THE RESOURCES AGENCY OF CALIFORNIA
<br /> Sum XV61 No
<br /> DEPARTMENT OF WAFER RESOURCES
<br /> :. Other Well NO.--
<br /> (1)
<br /> o. _—(1) OWNER: (11) WELL LOG( 1`
<br /> Name (..`l'l:.7 of SttCJ :1,ton Yowl d.,a1 it. Ltc+f• f ton,Idrt.J cell !t.'' �,
<br /> Address Fom..! n: 01,.,4,by 01-,rb.r.:ler,fate of rnJurbi,..d urs:tare £
<br /> 'i'ir'ir 2 of 2) a,to It. '1
<br /> (z) LOCATION OF WELL: 1. O 1.� I3'ia,.
<br /> C...tY Ownti t numbs,;(.0 iG 3115 FAtL I :•AT f1
<br /> Tcra.hiv,1t[n r .d S.ct;oe
<br /> Ui[tuee Isom titles.To.ra,raifro.d[,etc. <.1> 347
<br /> L+ Cy Cry•^�fI ,•
<br /> 347 — 357 Blue C zy '
<br /> (3) TYPE OF WORK (check): — a f Psi ue� ..7.':( • :3�rio'r ,b:
<br /> New veil ❑ Dtcpening O Reconditioning Q Destroying ❑ 367 380 EIlia 01-ay j
<br /> 11 destruction•Jew6be 0»steri d and tr9efdurt la lura 11. 1G — 303 Bb:.45 :iF1n:l 1
<br /> (4) PROPOSED USE (cbeclt): (S) EQUIPMENT: Gan bizbb1-:s gvjAe1E;'
<br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ _3t13 i,;
<br /> Irrigation ❑ Test Well ❑ Other ❑ Coble , [3X96 LG 'r
<br /> }33.uo CJa
<br /> Ocher
<br /> (6) CASING INSTALLED:
<br /> fTCEL: oT$d7;Rt If g.rawl Packed i i4
<br /> i
<br /> SINGLE❑ DOUBLE Q '! 1,�• ,:p.,
<br /> G'sc Diameter
<br /> From To or of From. To
<br /> fc. ft. Diam. Wall Ibrefu ft.
<br /> Sir.oI Aot oe well ling; Stxd of xr...it "1• t
<br /> Druribe';n.
<br /> (T) PERFORATIONS OR SCREEN:
<br /> Type of netlom;nn oe mme of screen
<br /> Perf. Rows
<br /> from To Pcr Pcr Sino
<br /> ft. it. row fc in.x in. t
<br /> ;t;
<br /> (8) CONSTRUCTION:
<br /> W.a 1,1.ct 1sn4ar7 seal Pro.id[d) Y.. 0 No To vha depth f.• i ,
<br /> 'Cue d.+ oat.sol«{.g,;mr potlolon) Y•+0 No 0 If pi,.e..d.11th of$(task •t• '"'l:'
<br /> Fn
<br /> it,rn ft. I 'r!'•
<br /> From ft.to (._ W.A.orctd ti ,C.,n lead 77 .1�,,7 •''r.
<br /> )✓..Shod of.,Al;hc WELL DRILLER'S STATEMENT: , •: •' ..• f,': .' •..Il.
<br /> This uvil mire drilled wader Stay jurlidierloa dad'tbir'rrport.is frac !o the her(
<br /> (9) WATER LEVELS: of my keowlydgr and belle/, '
<br /> OeOtA it vhleh vary waa fin.(j if known
<br /> Staedihr Ir-el Wore e40O ;n , if known !e. NAME '
<br /> Octwa,firm,ec.orrerati.n) (Y>Ped or jrl.erd)
<br /> and;eg I.v.l dime rtiforatint. .nd dawrlo ; ft.
<br /> (10) WELL TESTS: Address
<br /> Ors.pam +eft tnsdt) Yn Q No Q If ret by whom)
<br /> Y;.id: R.t,mia,with is.dr down due hn. SfONEO '•'�'
<br /> DtlUe)
<br /> T . e of wrt.t Wit a ehrmluf ons! aia made? Ye.0 No Q (Well
<br /> un.(rar
<br /> Vn de..r;c Ing male of well) Yr. 0 No If a,attach co License No. - nand
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE e !d
<br /> L:lY1i.I GIJ ffICV.a.dJJ, ..ti.,,.4j�..101'1:11"rZl�''C•�".I.rl vxt+. .l' di
<br /> 206 6bT 'ON 0L£9 Zb9 OTS F NOINDOlS Q(1W 00:60 96i91/0T
<br />
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