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Ccs-+'flinued Well.
<br /> 1
<br /> ,dIPLECArE 4Y^Tt<OfGhLIFORVIA DU rtoi fill 11
<br /> Owner's Copy THE RESO JRCSS AGENCY nI
<br /> DEPARTMENT OF WATER RESOURCES NO. 104075
<br /> WATER WELL DRILLERS REPORT slate l%eq No
<br /> other Well K"__•----_�R..�--._�-
<br /> ( ) ) OWNE11 , .�------- -� - (12) WELL LOc
<br /> Tn1x1 depth—it l]etrth of Cern,pletr.I acU,-__,r,H
<br /> Adtlrt,r _ front fe to N Formation (Destnhe ctll,rr, <har.s7icr sire nr +pt(rri+))
<br /> 546 14411 11=e a
<br /> ( 1) LOCATION OF WELL (SCt Inst rut ttoR,)
<br /> ( ""t> -- —�-_()I,,r i Well \t,ntber, __
<br /> 50 I�L
<br /> 11415 liddress It tl,'frrr„! from -let<{ -__ _ _ 5 75_
<br /> ,)„I+o,P flute, s,tlxr, toads rstllnoadi ft„�•i ere -.„,_,._.�.-, ���._-�„� ••••'!•• - •••
<br /> 595 - 5� a—n a Y
<br /> —^ (3) Type OF ti,
<br /> OR1. g�6 _C �i lA an
<br /> l+r.+ \tell u UrcltcntttF c 6 Q 3`'�'IO -�t,l .y `T
<br /> Stet.,nd,l,uplrlft ❑ - �Y..,--•--�-....._._� — -
<br /> Narlcnnlal It el! ❑ - - ----- -
<br /> 1)gltuetrnn
<br /> tlestntttion mnllarlat+
<br /> orra.'tdtire• In ltorn \ T '
<br /> (4) PAOP(OSED l
<br /> I)„meatfC
<br /> lirlltxtion+ ❑ ~
<br /> Indwttritl _..—
<br /> T Weil D -
<br /> �—-- - 42
<br /> -
<br /> %k E1.1, LOCATION�WrTCH - (hher� F, 0
<br /> (31 FQtlIPAfE _T 111) GlaAv ACR% \ \ -
<br /> }7nlrt7 ❑ Rtn•ra• t ❑ '�a Siz ..,. .-,..,._� ..
<br /> G,tls,� Gt Air ©
<br /> Uhler ❑ Bucket ❑ -
<br /> (7) CASIAG Ii ,; LED% fB1 PEA>F'ORA IL V e ---
<br /> Sleet ❑ Pl+tt 'j Co • TYn•of D•+ r \\
<br /> of rsm
<br /> Front 10 YDfs Ga `4 r F T, --
<br /> ft f in Wall it ft !
<br /> {8} 11,TLI, SEAL, -- - -- -
<br /> Nat ,urim;e snniar) seat nrovidc47 Yes © - �No CC It yes, to depth-..,_.—ft
<br /> \ler% ttr.ta seRled as%mrt voP4t7ne7 Yet ❑ No Q
<br /> %(Rhea% of .ealatR— Work start )9 completed-19—
<br /> ( 10)
<br /> om let IH( 10) WATER LEVZLSI NVELL DPJLL1 R'S STATEMENT,
<br /> i-)Qnth of lint water, If krv"Ma.-._-_..-_ u - ft ThCI wV11 roar dr111ed uodvr rr,y h(rixdeet„rti and thu trlrnrr fr Imre to rhe, 1rr,rt Of nti!
<br /> StandinK level Rker cell tumpktiap kanwlyd/1• and brllrf
<br /> (11) WELL TF,STSt --- _ - SiC\ta-,,._.
<br /> %%A, wel3 test nsr(ie7 lot �^] \t, (j if Yes b' -h„nili (Tell Dnllee)
<br /> ^i tort Pump A1r lift ❑ NA?LIF- .,.--
<br /> !, -Ater M tt+n of tett_ - It At end rf text eft (Fetsnn, firm or corporation) (T+7ted or printed)
<br /> •f(er....._.._ �hnurs Writer temperatv.rr_ Addrau- --
<br /> Che,rllc.,, analysis made' Yet © No (] If yCa, by µham%+,..,r.. , CI tY ----,.,,_. .,.� -�7t!__, -
<br /> 11461 elr (rsc 1<,v sondes }n Q �.. No 11 ttltTPltiCh<n(ty
<br /> It,thli rt-- Licetite Ao r - � ^, t!of lhlt relon.-
<br /> DwR INe tRty 7 7.1 IF ADDITIONAL SPACE IS N1=EDCD, USE NEXT CONSECUTIVELY NUMBERED FORM
<br /> 6r r!r II/ter+ n nor n el .......
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