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l 0;31GIIVA! THE REZOURCES AGENCY Do not fit! in <br /> File With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPoRT No. 313 819 <br /> Notice of Intent Na <br /> Luca)Permit No.or Date 7—p-11 Stale Welt No <br /> fhher Well Nn <br /> (1) 0"'NER: Name (I2) WELL LOG: Tataldrpth,,.��' ft.CanpletedJ*h it <br /> Address <br /> City � nom. r from ft. In ft. FormatlourChncrihebycolor,ehirader.�eormates'fan <br /> . ZIP9r�i <br /> (2) LOCA'T'ION OF WELL(See:instructions): — <br /> s}urnly f)wurrw W1,11 Number — <br /> «'rll aeldrrss if r ffirrrn from al,nvrAj EL Do t. — <br /> Tnwnvhi <br /> Distance fnrm r irs•irut%railrrnrl.,,fence.•etc. — <br /> 1 <br /> iloee <br /> T <br /> I _ <br /> F1)TYPE OF WORK: <br /> New Well ❑ Deepening ❑ — - <br /> Recomtruction ❑ — r1sL <br /> ReconditioningF [] <br /> 4 HjeRr1d,21 Horizontal Well ❑ or f ; <br /> _—- r S* Destruction ❑ (Describe — <br /> destruction materials and pro- <br /> cedures in Item 12) 61 <br /> �°• h (4) PROPOSED US . <br /> 'FbNru�atued �/wprt eyelt <br /> 5e r•J7 Cr 'O Q•3•A Dnmestic _ <br /> STRILaN g Irrigation <br /> w + Industrial✓ _ i <br /> '4 Test Well o ❑ <br /> Munici ❑ <br /> - WELL LOCATION SVErCH ibe) V - <br /> (5)EQUIPMENT; CRAV Ca; <br /> Rdary❑ Raverac i-.t No Si <br /> Cable ❑ Air p N of bare ' <br /> Other ❑ `Buck ed ram <br /> (T)CA,51NC IHS1'ALl.cn (a)P TI _ <br /> Steel QPlutfr 7y d on er sed Q _ <br /> F%m f Cage ar t _ <br /> a1I size _ <br /> 4 — <br /> -— — (9) WELL SEAL: <br /> Was surf"sanitary mal ? - <br /> provided. Yet� No❑ Ilyq.ladep�h��lt _ - - <br /> . - - Weremrataantedasaimtpolution? Yea❑ No 25 Interval It <br /> Method daealina Wntk started 19 Cnm )g <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> r.. Depth of first water,it known [t. - - - - <br /> 5randingfe rd after—11 compllion A-4- it This well ueae drifted under sy jariwiier and thu nue ue io the <br /> best of dRlea br(z� <br /> (II) WELL TESTS: <br /> Was well ten mode? Ya❑ No❑ If yea by whom? Sigurd <br /> Type of test Pump❑ - Rader d rl <br /> Airlift l' NA\Ili <br /> _ - Depth to water at star)of test R, - it end of rrsr ft rYrr .r—pon• l e .pert raadl - <br /> DiAAArge - gal/minallrr haute Waieriemprnru" Addressf�' - <br /> t'.hrm�ral analysu made? Yrs El N.❑ If vrs•1-wh—? (:ilv .i!`S Zip WZ02 - <br /> _ v..7 d....ararF+nmvinlhi.r-1 1 Teruo.\n. <br /> 1trnt 1hi.rrrnrl <br /> I). <br />