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erp <br /> AIPLECATE <br /> Owner's Copy s7ATt Oe 1U 73x7( fill i, <br /> THF' RESOIJ RCCrs AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 100075 <br /> WA1 Ut N'VELL DRILLERS REPORT <br /> •„ lir Mit ...-.,... <br /> Other I% <br />{l ) OWNER <br /> _-- <br /> A,irls,., �12) WELL LOC} Tnwf dr <br /> �,.__y lr,.m ft <br /> to ft 1'nrrnatir,n (f s,nhe rafor char+Cte tyre or "',ferl,tl) <br /> P) LOCATION Ola WELD, {Stn lustrttt tura) --- - �$�-- Z), _.._.., ..� <br /> t HI ilt� <br /> '_'-_"."---�---------�-4...—Clwrvr t Well \Inibrr-__ - <br /> llti,ll nl[dfers if di'ftrrni ft'-, Nlit kr� <br /> --- <br /> Jl.l+n,r lrnm 'ttfrt Mads r>tlIt,ad, re II,rr etc _ _ -� �7 <br /> 595 --5-79 ars <br /> (3) 'f}PF 4F 5}t(1Ri. � f5� _ _=C�'� tZ AXI <br /> c b43 10 Biu Ay <br /> t nl - <br /> J lies,n,t ru41, „ i L] <br /> If Q$inJUI(In r*,Ylbril It <br /> 1>rrxr,ly ref <br /> (4) PROP(3S£D - -- - <br /> ITrtffvt(on C] � \ <br /> 1- it)h `m 1 <br /> 3} FQf1tPp1E'+<'Tttnl,er�.r fir-♦ [} -.---..---�.- <br /> ft1) (:RAVPte, ACKf `� ` -'---�- ------ <br /> ntart q 11wc�� ` <br /> C� �(� '�'r Six -^---------- <br />+hlr Q Air Q r of bore"__._.._ �- <br /> cher Q Bucket ❑ �m t ♦ _ - - <br /> 7l CA51AG Ih4TtALLED¢ <br /> ecI ❑ 1•AtItIC ❑ Cr, 7 <br /> YD+of w a ut zo of scrc,r _ <br /> From 10/ -Dfo Ca r r F <br /> ft fin Wall ft ft — <br /> I) INIF- , SEAL, <br /> a+ ,urf�Ct YNRi,f) <br /> Wil' Prodded? Yet 0 _ No G If yez, to depih-_--_ k <br /> en, hrrgta SCRled 81 ilnrt pnllutlnn7 Yet �] Nn C) -�-- <br /> Sh,rcf of teailnR,,,... �- <br /> Mork <br /> R <br /> 1th WATER L£�'r lin <br /> fPWELL DRILLER`5 STATEMENT. <br /> tr( first wgirr. it <br /> knm,.� � <br />,ladinf. lc�cl RArr, ,.rlI This "I'l ,oar drllfed under my hiriidicnmr and fh,r trimrr is inr, fu t1l, Irrxt Pf n,y <br /> _ ,f_��mpktion �N knowledge and hrlirf <br /> 1 ) 1YE1rL Tf STS, � = <br />„ "ell tc,t n,mdel - - <br /> hn Q If Yrs h, whnn,7 -- -(\Yell Dn11,:r1 <br /> pt of rr.t Pump Q Nt4lrr (� Air LFr <br /> Ammer at $tart of recL It NAAtF'--.._� —� <br /> �t end rf iert ....__ft (Pertnn, firm or trrrrmrFtlnn) (Tkped oT primed, <br /> �._xol/rnln after-.--._.._.—hmIn iiR,rr 1e„Iperaturc � Add:n$-,--,,,,,..,,.—.._ <br /> e,»lc„r anillyth m■dr° Yty ❑ Ao Q !r yet, hN .hnmP ,. City <br /> (] ho 1f ,yt,, Rttxh cnfT,r to thrti nM�rt _ Licen$tr Ao_�-- _ _ �„_�pate of thlr rupnrr*.__.,. <br /> I+F tfla! trios >>sl 1F ADb1TlQNAZ_ SPACE IS NEED`tsf�, tJ5E NE)CT COPl91rCUTlVELY NUM[3>tF7!"p FrDR►.ri `- _.._�..-__.____ <br /> -Mll AA to <br />