Laserfiche WebLink
r <br /> STATE OF CALJFDRP41A <br /> j DUPLICATE THE RESOURCES AGENCY Do not fill in <br /> S Copy/ DEPARTMEIJT OF WATER RESOURCES <br /> JI WATER WELL DRILLERS REPORT No. 313809 <br /> Notice of Intent NcL State Well Na. <br /> Local Permit No.or Date Other Well No <br /> (1) OWNER: me (12) WELL LOC: Total depth��ft.Completed depth <br /> -;Za fl. <br /> Address 1,9 from ft. to ft. Formation(Describe by color,character,size or material) <br /> City lvoj- L'ngazv 21P <br /> (2) L AT10 OF WELL(See instructions): — c <br /> Clau =_Sedion <br /> T41W r r r 4kr / MJL <br /> laddess if dirfercn om above _ <br /> Township Ran %n e t• L,rp <br /> Dista e f m cities,roes rail — <br /> /) <br /> do <br /> 0YJ A/1 d - o Sated. <br /> (3)TYPE OF WORK: — 2,t t{ S u i—rOKr� C!J <br /> - - New Well ❑ Deepening ❑ <br /> Reconstruction ❑ <br /> i Reconditioning ❑ <br /> �` •� Horizontal Well ❑ — <br /> I`I Destruction❑ (Describe — <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> pp (4) PROPOSED U _ <br /> Domestic — <br /> Irrigation <br /> Industrial Q ❑ _ <br /> Tat Well ❑ <br /> 1 Munic ❑ — O <br /> 1 er'be) <br /> WELL LOCATION SKSICFi �) r <br /> (5)WUIPMENT: RA CK: — <br /> jAotary Id's ltevtese ❑ No Si <br /> Ii Cable ❑ Air ❑ et of bore <br /> a ❑ Ruck a ed from — <br /> rt — <br /> • (7) C NSTALL [g}P A . <br /> Steel ❑ Plastic a Ty of ion or riff _ <br /> From o D'a Gage or of — <br /> ft. Wsl7 size <br /> r D � T <br /> (9) WELL SEAL: _ <br /> - _ Wasaurfamnnitarysealprovided? Yes& NOD Ifyeytadepffi ._ <br /> Werealratasaledagalrutpollution? Yes A No❑ Interval f2—/C fL — <br /> Methode(mling f Work started I9 Com feted — t9 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> lkpth of first water.Lf ktnwn _fL <br /> Standingkvelaflrrw:!]rorrrpklion This uwlt was drilled under m toriselfckfors and this rrlwrf is true to the <br /> IL Lest of my ledge and belts <br /> (11) WELL TESTS: Signed <br /> Was well int made? Yes X No❑ If yes b wham? ��' vel 'llrrf / <br /> Typroitnl Pump❑ Aailrr iv Fir lift ❑ NAME L`�4l F � t'*`�� <br /> .,4 Depth to water at start oftest ft. At rndof lrst ft, ersnn.flmr,stem lt_ratlga�f'j7ypedur printed) <br /> --- -- � — 014chargc g 11min dl r horn- -- Water r at'" Address -- <br /> . _ I Chemical analysis made? Yn No❑ If yrs by wlarm? 0 4 City l Z p .S—' .S �—r� <br /> . � Waseknrlrkgmade Yn❑ No❑ tfYrr.anadrnr+ bdhlrrenrl LlcenseNn ..� ' Uatro(Ihste[xr;t;�—?� <br /> Owrt Inp TREY. tx�; IF ApOIT[ONgL SPACC i5 NEEOEp,U9E NC%T CONSt:CUTIVEI.Y NUM eEREp FORM <br /> 06 r6' <br />