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e C lt1C:�l'��IL $rA-rd a,r CAU19C tNIA OI t <br /> ' THM REISA028 AGENCY Do not fill in <br /> File (fi DWR ❑apAaterl�ivr OF wkseR RMsovltCes <br /> SitWATER WELL DRILLERS REPORT No. 371940 <br /> once of Intent Na / Steta Well Na <br /> ' <br /> L40czkl Parmit Na or bate <br /> allay Wall H <br /> (1) OWNE$; Net= (12) WELL LOG: Total depth 116itcomplaiI Ft <br /> ' Address <br /> City from Ft to It Formation(DEmertbe by calor,cltarae}ar,sfza or material} <br /> ZIP <br /> (2) LOCATION OF W$L.L(Sea fnshuctlons); — <br />' County an Joaquin owner's WallNumbar = <br /> Well address if fronnabove <br /> Township govy Sectlen <br /> Diatanve from cities road%.reilrmuj%feacm Ole, We'1 l according to the Rules <br /> and Regulations Of oa uin Count <br /> Fill Xram bout to with cement <br /> grout-"Cured t h a tremin e <br />' (S)TYPE Ol? WORK- <br /> Now <br /> ORx New Well ❑ Deepaning ❑ <br /> Reconstruction ❑ — <br /> NIN <br /> Ilawtxl#toning C3 <br />' HatfWatal Well ❑ <br /> Dastrtut(o�a Eo( (Describe <br /> destruction matar(alr and]pro- <br /> des <br /> in Item!S) <br />' (4) PROPOSED US = <br /> balneat(c �[ <br /> Irrigation <br /> Industrial ❑ <br /> Tont Well � [� <br /> Munlof VVY ❑ <br /> er <br /> WELL LOCATION SKETCH til <br /> (5}SQUIPDAL+NT� CRA CKr <br /> Rotary O <br /> Cable ❑ Art ❑ al Flora <br />' Other ❑ Buck — <br /> ('n CASING INSPALLFX)h (8} PSA O T <br />' Sisal ❑ Plaids ❑ Ty of arslsend <br /> Pkarn G e or T <br /> ft. f i Well <br /> (9) W& SEAL: <br /> W assurfaca mainly ma provided? Yes ❑ Na ® ,tf ym,to depth-..---_-..ft. — <br /> Woresirat-xmIadaeafastpollatlon? Yes ❑ Na$]' Iataxval_ft —77 <br /> MettuodoEsesllag Work starteds-2A <br /> (10) WA,.TI;R LCVELS: :WELL4DIRECS'STAT <br /> Depth of Fiat wate.If kroownEtStanding lard afterwa compladm a and 1 e glue o the <br /> e ti <br /> (11) WELL TESTS: <br /> Was well test made? Yas Cl No Fp If m bywhmp Signed A`ye Dr <br /> pa of tat pump ❑ Sai]ee Q Air lift ❑ NAME <br /> pthtowateratstartoftest ft. Atendotlest -� —,ft Perlad rht, aupaln }(fypedorprinled} <br /> Llischargp dpi/inln.iErr hour, Wot.:tenpamtum Address 70 <br /> Chemical analysis tnada? Yes ❑ Na [E yes,br wltatnP City ZIP <br /> I Waselecla log made Yos ❑ Na M H m attaRheopytolhissecod ILICUZUEND. 3 7 1 Dateafthis rewrt <br /> OWN lata IREIN. i,J418) b'ADE)MONAL SPAGS r8 NEEMna. US6 NgCp CON_-MCU71VULY LVL7MB9RIM FORM <br /> ga ssLi73 <br /> I <br />