Laserfiche WebLink
x <br /> -MM. E�Z�Zkli1-gi;1.11 <br /> IN <br /> STATE OF CALIFOnNIA <br /> DUPLICATE THE RESOURCES AGENCY <br /> Driller's Copy DEPARTMENT OF WATER RESOURCES Do not fill in <br /> WATER WELL DRILLERS REPORT N0. 313810 <br /> Notice of Wrnl No. <br /> Slate Well No. <br /> f Lacaf Permit Na or Da[e Other Well No <br /> (1) OWNER: Name o depth(12) WELL LOC: Total de Zl <br /> Address p -yL ft.Completed depth fl, <br /> j <br /> city ` ZIP 5 from ft, to It. Formation(Describe by color,character,size or material) <br /> /n ed F.- s.'L I-- <br /> (2) LOCATION OF WELL(See instructions): — 1c) le, 4 <br /> County r Owner's Well Number <br /> Well address if different from above 1 Y vr <br /> Township Range Section ry ,r <br /> Distance from cities,roads,railroad;fences.etc. — 6�r Fd <br /> rrv5 ►'1RUPI, <br /> �. a-avrtL <br /> (R)TYPE OF WORK: 5ee�i ja r Gr a r 5,q,1 <br /> New Well 0 Deepening ❑ — 0 r kG Z AF <br /> Reconstruction ❑ — 11 Ade.- Df}7G� <br /> f Reconditioning ❑ <br /> Horizontal Well ❑ �" !Y"1 p r_n � <br /> Aestruction ❑ (Describe — <br /> f k1 f rR t c riJE <br /> destruction materials.Ln d pro l <br /> . cedures in Item 12) <br /> Ta rir <br /> ,yam (4) PROPOSED D_ d ' <br /> - - Domestic <br /> Irrigation ce) r aC . S TQ v.0 Kf6 <br /> Industrial ❑ <br /> Test well 0Or r y <br /> Munici ❑ a O 1 e n <br /> cr <br /> — AO rad 's" <br /> _ WELL LOCATION SKETCH 'be) 1 All <br /> (5)EQUIPMENT'. CRAV — - - <br /> ��[[ CK: <br /> . 1 Rota7hs fteverre ❑ No <br /> f Cab e ❑ Air ❑ de of Lore <br /> Other Buck from <br /> 14 qf .— <br /> (7}CASING INSTA !.E (s)P TI <br /> Steel ❑ Plast c e Ty of mor sired Qa <br /> From D- . Cage or of ` <br /> Ft. f Wall L size <br /> (9) WELL SEAL: / _ <br /> Was surface unitaryseal pmvfded? Yes NOD If Y-1 to depth i'Q ft _ <br /> WeresImtarakdagaimtMlfotioni Y No❑ Interval ft _ <br /> Me<hodof sealing (j 'Y l Work started 19 Complel I <br /> DePtF10WATER LEVELS: 4— WELL DRTLLER'S STATEMENT: <br /> - . Prpth of fiat weer,if known fl. <br /> staadin kvelafter-11corrl !erton This well runs drilled_ Under..nt -jurisdirlfon.and-this report-is-true-to <br />— ---------I- g - p..... -ft.- bcrf of try knowledg and b tcl ---- — ---- <br /> (11) WELL TESTS: <br /> - - Wes welt tot made? Yes❑ No❑ if yea v 7 <br /> Typed ted - �- / (Welt Driller <br /> �mP��� Hrikr � . Airlift ❑ NAMI~ !� P i Na <br /> `.� Depth to wane at dart of IN---lir. � Ar end of Iest (l_ _ <br /> r1 yor.v '0iTy or printed) <br /> I)Lwharge gal/min after tarns Watertemprrarurr Address <br /> Cheminiamlyrismade? Yes❑ No❑ ifymbywirrn? - City - r 1' 'LIY S / <br /> I <br /> - Was eketoc made Yes❑ No❑ If yrs,alrachcopytolhis«rwl Lirrnx•Nn. - <br /> i)alro(thisrepnrt I' _ <br /> 1 AWR I"tREV ta-661 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTtVEI_Y NUMFIERED FORM <br /> 96 vas' <br />