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CustOmcr oStcincd peradt
<br /> QUADRUPLICATE .TATE OP CA a TO n.r I A
<br /> Do not f+ll fR
<br /> UMOfcomply WI}II THE RESOURCES AGENCY' A
<br /> lowlrsqulremeriN DEPARTMENT OF WATER RESOURCES No. 187148
<br /> ort4r.d ln,emt N.. ___ NATER WELL DRILLERS REPORT
<br /> Ina.l Ihmnh Nn.n.Dar _ (w,er YYrn Nn.
<br /> (1) OWNER: N _j;0ornanP ➢ia—�,`-.yete�s (12) WELL LOC: r.•ud drnrl,.l�Cur.lko+n,a r,•ma4hd.rltQo.
<br /> Ada 2120 WilCOX Road m,.. ,r h. h. Fn,mnm•n flkvenhe hV mhn. rhnmehr. .ke ,.r marwu
<br /> cm•�.Tiogkton. Calif. ,Ind -. 0 - 5 :land
<br /> (2) L?CATION OF WELL. (s,,jn lelrclfons): —5� - C
<br /> c,mn 8II cip-q in D„.,•:.svrn Number - u d
<br /> a•«t.Idle,.if ddlertM rm,n.nm< 10411 S. Small Rd. •C - e72 Cla
<br /> Tn.m,ll„Fronch Canfian.r ,„ F, an
<br /> DIM.rR./mm ewes,nW.,m1ImW.,4nae.,«e t, - ILU G - .
<br /> 1C£ - 111 Sand
<br /> 11 - 1)2, t; ay
<br /> - san
<br /> (3) TYPE OF WORK: 1 -•lou Ulay—
<br /> ' Sew N'euX Der:<nin¢❑ -:.
<br /> Reomditinnin4 ❑ -
<br /> W'd..mbl well ❑ - -
<br /> Dentr,RUnn❑ (Ik.rrihe - • . - -
<br /> drmrathm fte
<br /> PnRMum In. heme, fEY - -
<br /> (4) PROPOSED UM,
<br /> privy.
<br /> Irrk,ehm.��� ❑
<br /> IMmtrl,l ❑ -
<br /> TeR%%'ell • '� ❑ -
<br /> Shc! ❑ -
<br /> Nunl<Ip,l' ❑ -WELL LOCATION SKETCH - kwKr ❑ - -
<br /> (3) EQUIPMENT (A) CAAYEL PACE, -
<br /> Rwy a Ae ee ❑ - Yn Q No❑ Sue Actafirir, -
<br /> C.h4 C Al, ❑ `. U,me,er M w-
<br /> 0
<br /> ❑ ll rka ❑ P,atad 1nm, 5C In {�1f. -
<br /> (T) CASISC INSTALLED:; IR) PERFORATIONS, -
<br /> Strel❑ PI,M4 C..+n rMe'O, T,M of,rt,h,ra,irm n,4r..4.e, . -
<br /> F.I., To - DI.. Com or Fno rt - To Slot -
<br /> 3. ft. in. Wall fL ft. siw
<br /> � I
<br /> 0
<br /> (0) WELL SEAL: �/ -
<br /> %V..,.der unimy.<.1 nnnv4d? Yee [3= Nn ^u It >r+. m 1s:
<br /> demi, _I,.
<br /> Mem wm -led apin., Pdlnevm? 1'n ❑ Sn ❑ Iv<nal ft.
<br /> .'« of .A .e. Tfnn tnnitn _-. W-•
<br /> (10) WATER LEVELS: NVELL DRILLER'S STATEMENT:
<br /> Deph ,d Rn, +r.me. it b..w- .__ le Thi, —If.0 d,,ILJ uw4, ., iu.hd4linii ,M rhb rrP.n h line m he Mn nl mV
<br /> S,.Nme k,.l aW.rA a mn4eb.n _ h. k+muled,e and beh.f.
<br /> (11) WELL TESTS:
<br /> ak1, w.0 1—t muk' Y. C S.:-- 11 ser, be „h•nu?___ (Well Driller)
<br /> T,,"d,mt 1,—, c: nuY.❑ Ai, lift NAME__L81wAt8r JT 33Jn.L
<br /> fiend, t•, •aee M .0 +d I.t It. Al eml -d to, h 11•ervn,C,m. ,r,r,wnainn) I rMd nr ndm.dl
<br /> Di.rLamr oVmin Jerr__.�mn \S',en ,enn.mmm Add,..._ 3Cv II. 'filmy
<br /> I ul ,n.tr+h n„dr? re. N•.C u ,e,. by -h,-?—
<br /> :"—-,
<br /> Mu e4mrie SK made? Ve,f7 S., li .u.,h nmy en,hi, ,<n•rt
<br /> DWR life '+CV 7 T., IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
<br />
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