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a <br /> STATE OF GAuFORNIA ill tel <br /> THE RESOURCES AGENCY DD not f <br /> DUPLICATE DEPARTMENT OF WATER RESOIJIFICES <br /> f Driller's CopyWATER WELL DRILLERS REPORT N0. 313811 <br /> Slate well Na. <br /> Notice of Intent No. Other Well No. <br /> i Local Permit No or Bate _ <br /> fl. <br /> (1) OWII,ER: Name r Coe< (12) WELL LOG: Total depth _f!.Completed depth ��-- <br /> K from Et. to ft. Formation(Dewrihe by color,character,size 0V <br /> Address alUtal) �L <br /> LIP 4 f� rir <br /> Cit <br /> (2) L ATI !+WELL(See instructio ts): /�— jl y r, E ; <br /> Count r Owner's Well Number <br /> Well address if different f shave <br /> Township,.,_.rRange Section — —�o irIri <br /> Distance from cities roads railroad;fences de _ ver �u ¢ — <br /> _ <br /> kc <br /> ,e,' Gie.1Gi �r3 <br /> (3)TYPE OF WORK: J f� C <br /> New Well ❑ Deepening ❑ _ ,e / L� 1 .,_. <br /> Reconstruction ❑ S <br /> Reconditioning ❑ Z — <br /> Horizontal Well ❑ <br /> Destruction )"c" ) S r of 1 <br /> destruction materials and Pro- <br /> cedures in Item 12) S ARTw <br /> (4) PROPOSED U — <br /> Domestic <br /> Irrigation <br /> Industrial ❑ <br /> J Test well O ❑ <br /> Mrmic ❑ 0 <br /> I er <br /> - - \YELL LOCATION SKETCH <br /> (5)EQUIPMENT: CRA CK: _ <br /> Rotary Reverre ❑ No Si <br /> table ❑ Air ❑ met of bore _ <br /> . <br /> Ott ❑ Buck ed from _ <br /> " r <br /> (7)CASING 1 AL1.E1) {el PE ATI — <br /> ! ion or stm of. — <br /> - - Steel ❑ Plasllc� - e TY of <br /> From o D' Cmc" r <br /> ft. size <br /> iJ, <br /> CO) WELL SEAL: J <br /> It es wde h Er. <br /> WusurFaeelanilaryaealpmvWed? Yes No❑ Y Fx /� <br /> 1lunon? Y No lmerval -!r. <br /> Weresirstaselkdagainsl t �. Ig^ m leled��1l <br /> 1•fethod of sealing , work started, <br /> WELL DRILLER'S STATEMENT: <br /> (10) WA'T'ER LEVELS: <br /> Drpthaflirsiwatet,llknown FL This uxfl tax drilled under nrq furlsdfctfon and this report is lrue io the <br /> - Slandinglevddlrrwcprnmpks;on— � - --------------------------- ---- ---- <br /> (11) WELL TESTS: ,y� ' /F Signed (W ID 11 <br /> Waswelllesrmadr? Yes Kll Non 11Y� "'h0A`? All ❑ E:Fx I / r — <br /> Type off I � PumP❑ &iter NANIE _ n,flrm.orsorpo7001 orprinied) <br /> lesr_. A4 fl. Address rr(, <br /> Alendnkiest h. � � r /rrS �C ' <br /> Depthtowaletatstartof /l �G <br /> Ihrch-ti, gll/min afire hours Water ,lrmprnmre Zll' <br /> Chemical analysis made? Yes 0 No E3I(yrs,by whmrt? City _ <br /> �d/fin DaleoElhisrc,�ri 4 <br /> WFsrlectrieksgmade Yes[I No❑ if yenauach cony In this report Lice Nn - <br /> IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSEECUYIVELY NUMt3ERED FORM Its %173 <br /> _ <br /> 13WR 100 tREY.12.061 - - <br />