Laserfiche WebLink
F� <br /> M <br /> g. x .,. _ <br /> : P y <br /> RrATti or CAI FQMIA <br /> ORIGINAL Tug RZ5==a6 AG&RCY Do not fill in <br /> Foie With DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 313814 <br /> Notice J Intent No Slate Wel[No. <br /> kcal Permit No nr!1ata 7-f— Other Well No. <br /> (1) OWNER: Name r (12) WELL LOG: Total depth_T ft.Completed depth­19 .fL <br /> Address <br /> from ft to ft Formation(Describe by ccbr,character,riot or Material) <br /> l ity02- <br /> xIP _ <br /> (2) LOCATION OF WELL(See instructions): - r <br /> (ixintySe252 M19[4_Owners Well Number <br /> W - <br /> !� - ?sArd 2ne iss�- <br /> r•II address if diffrrral torn afsnvr - <br /> r_ i J <br /> Township--t e. <br /> -_ter Qj �f1an;Ge S:rtion � <br /> Uislancr frn.m edits,rnsds.radrruds,fences etc. <br /> - r <br /> i3l TYPE OF WORK. <br /> New Well [] DrYpeninl; ❑ <br /> Reconstruction ❑ <br /> Reconditioning 0- <br /> Horizontal <br /> Horizontal Well ❑ Rl/A/ceptss S� Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) - <br /> URAoR ld) PROPOSED 4- US . <br /> c <br /> Domestic _ <br /> Irrigation <br /> Industrial _ <br /> (`A' Q 1• Test Well O ❑ <br /> Munici1 0 _ <br /> er <br /> WELL LOCATION SKETCH be) - <br /> (5) EQUIPMENT: CRAY CK: <br /> _ - - RotaryClReverse {] N <br /> .. cable Cl Air 11ere f bare <br /> Other ❑ Buck tom <br /> (7)CASI ANSTALL lBl PER Tl Q _ <br /> Steri ❑ llwk ta Ty aF ocrlrrd <br /> From T r ti- . Cage or t - <br /> Lt f i Wall size _ <br /> (9) WELL SEAL: / - <br /> Waamrf.unitarysealproviWF YoUL No❑ tfyes.todoprh�j~ ft - <br /> . <br /> were arstasnledasaimaPollution? Yes❑ No(9 Interval __ft <br /> Method dsealing ¢ � Work started � 19 Com leted <br /> - ------------ (10)-WATER-LEVELS: ---...------ ------ ---------- WELL_DRILLER'S_STATEMENT:__-- — ---------_._---- _-_-- <br /> Depthof first water.9 knowts. i n - - It - - - - - <br /> AJ n d p This well mos drilled under m duns ctfon an this report is true to the <br /> Staradioltlevelafterwellaampition ft. brat of my Ano•tedj? ndhr!!e <br /> (11) WELL TESTS: sl$ped <br /> .,.Wu Ilwoude? Yes❑ No Elom <br /> If yrs,by wh ? - ----- r nl <br /> k./Typa rf test Pump❑ Reiter❑ Air vi Cl _ NAME <br /> Oephto.aer ai start al tea Ir -: At end of rest ft. IpenOn' or mrp9wt �y5pcd or prinrpdi/ <br /> Dischme WImmour after hWaiertemperalure Address �l�—•— <br /> Chemkvlanaltnsmade? Yes ❑ No❑ Ifyet,bywhom? City }--•--• - "LEP <br /> Waa A-mt,r tea made Yrs 0 -No❑ If see,auach«rpv mihu rrpan Lirrnsr\a naienf ibis report <br /> oww 100 Inay. 134M IF ADDITIONAL SPACE IS NEEDED.USE NEXT C6N5ECUTIVELY NUMBERED FORM : - - - <br />