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r <br /> f <br /> gR�Vi�a�� RTATIS CW CALIMIMIA <br /> ORIGINAL TMit RUZOURC93 ACWNCY Do nda, <br /> File with ID1WR DEPARTMENT OF WATER RESOURCES J• <br /> WATER WELL DRILLERS REPORT No. 313825 <br /> Notice of intent Na <br /> Local Permit Na or Date ee—r 91 Q*ft WA Pd. <br /> 17ther Wd Yn�4 <br /> Address—e2O Name (12) WELL LOC: Tout defx6�{,�e <br /> City ZIP from ft. in It Fa tion(Dncri ebya ,tbmmo*.sheoraw <br /> (2) LOCATION OF WELL(See instructions): <br /> S nnnty Owners Well Number —A <br /> Town address if diR— xrnt from above _ <br /> Township Itange 1'im-fiun / <br /> Distan—Imus citim rrasds,railrnit%fene,rlc. - <br /> e <br /> e16 4 <br /> e.: <br /> Ia)TYPF, OF WORF. <br /> few Wolf ❑ >'f"ing ❑ '- <br /> lirnmstruction ❑ — <br /> Roasnditioning ❑ <br /> Horizontal Well ❑ — <br /> �! 12s�f S t � n❑ �dudlnnutenid pra <br /> cedures in Item 12) <br /> (4) PROPOSED LAS _ <br /> �(}t�oa86' Ia Ls7�aa. E3amesUc <br /> 440}r00 11 Irrigation — <br /> C Y 4-3-8 Industria[ <br /> Test Well O <br /> ,F Munici ❑ <br /> r o <br /> - WELL LOCATION sKETCH be) — <br /> 15)EQUIPMENT-. CRAV CK: <br /> . . Rdary❑ Rrrerse ❑ No Si - <br /> Cable ❑ <br /> Air ❑ N .16— <br /> Other <br /> fboreOther ❑ Sack ed root <br /> 171 iD" <br /> INSTALL fi r 18)P T[ - <br /> steel❑ :iastie % TY of or aim of Q _ <br /> From Gagge or t <br /> Ft. F Wa11 t L size _ <br /> �d -Se A q61 <br /> (9) WELL SEAL: <br /> Waw turfaer unitaryseal provided? Ya No❑ if yrs,to dWh j14"/ ft _ <br /> Were strata waled asairat pottullan? Yeo❑ No L$ Interval <br /> hfethoddsnlinR !� 'jD <br /> --- Work stuffed Ig e <br /> =----- — ------- WATER-LEVELS:— _._... ---- --... --..... WELL DRILLERS STATEMEti'?: <br /> Depth of fiw weer.if known— It <br /> slartdinylevelafter well compirtion N 0P Le „_fl. ThLs wl!uwa drilled under m ju ' and nWn 4 tray to t6 <br /> best o/my kno Itc ge and bower- <br /> (11) WELL TESTS: <br /> Was well tat made? Ya ❑ No❑ If ym by whom? ^, Signed <br /> . _ <br /> Type oftea Pump❑ Baikr ❑ Airlift ❑ - - . <br /> Depth to waler at start of lest Al end octet ft. NAME <br /> _ fiw iPe firteL or I.Fdr• }_ - <br /> rar <br /> . Diachanie gallminallrr hosira Watrrtempenmre Addr - - <br /> ' <br /> Chemical anatpit made? Ya❑ Nn ? <br /> ❑ If yea by whom. City <br /> Waselretririnemade Yes❑ N.. ❑ IfrmaitarhCopy rothis wpm, License Nn Q Uatrofthuureport <br /> DWR tae IREV. 12-aal IF ADDITIONAL SPACE IS NEEDED. USC NEXT CONSECUTIVELY NUMBERED FORM - <br /> r <br />