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rA <br /> ? QUADRUPLICATE STATE OF CALIFORNI a Do n t fill)CL <br /> Use toacompty with TME RESOU RCES AGENCY ^e <br /> -local requirements 09 <br /> DEPARTMENT OF WATER RESOURCES No. 7937 <br /> Nor.or Imeo,No 881--��- __ WATER WELL DRILLERS REPORT state Well <br /> Lmel Pen-alt Nn.or Date 51_Vy6pother Well <br /> (1) OW}��py N K� mr (12) WELL LOG: n�ml d. th .Sri <br /> 'YY 0 ve: �!` -- n `I b Dwtb of nm rr.t.d weJ r. <br /> Addnn �Y N aS�,yt Imm ft to ft. n /Dncrb by a 10r, rhnnd,n Itto_mateda) <br /> Y Y.KVJ rmo <br /> carr alt- 4111111,r mm <br /> (2) LOfyOTIOJV OF 4YELL (Seeinstmctiom): <br /> i, Conner. «Qu17L Oameh Well Nmnber Lay <br /> i• <br /> Nell eddma If dlrfe.ml fmm above_ _ % Iiiimy <br /> Toweehln Ann¢���7gL��a.eln <br /> Obtanra fmm dna,, mai,,rnllnnd,,lenrna,etc "" '-"• <br /> (3) TYPE OF WORK, <br /> New Well DIZDeePenlnR❑ <br /> 7 -��. Reeavtvellnn 13 - <br /> _ ReeorMitionine ❑ _ U_'_. <br /> N d tel Well ❑ <br /> y7 ; <br /> Duateiieto.n❑ (oaI Hb. - <br /> a �..,\. It�ileHmeb > <br /> �^ <br /> 1=11 e' <br /> (4) PROPOSED - $ <br /> D000.d. k� <br /> :to <br /> atrnh <br /> la-211._ <br /> ?I ar wdI ❑ - ;& _ <br /> LOCATION SKETCH Other - ' - 't ' it' <br /> \il -(5) F.OUIPM1IENT: (A) SAN <br /> A PACK: <br /> 1 Rola' C)T- No S' - 1 •m>n9t>s <br /> aQ C.I IF ❑ Ab ❑ er of bora •� <br /> j Other ❑ flu.ket. ❑ - Cel <br /> CASING INSTALLED (R) PE"t, <br /> ' Steel ❑ -Ple,rie [:?c C Type of M trosane - <br /> �.( Froin TDfE. Gr r F To <br /> f[. f in. ' Wail fL s <br /> f = <br /> 7 (9) WELL SEAL <br /> t� \va d nil rr 1 rmeldN? lee [X N. ❑ 1f p'e., to <br /> Were Pirate ,ealed uelmt lint ? Yea ❑ No <br /> k Mere of aualin ®I�t \Vnh abw.A 19_._ C mylete' __l9 <br /> r rER_ - WELL DRILLERS STATEMENT: - <br /> (!9 <br /> WATER LEVELS ' r' <br /> > Deed r feet water,-If know ----1L .Tab:ueit uw,ydt McYMy I rldleflon ane rnN .rron o mgr m rh< ne,t I v <br /> Shml C Yvel'nle enmmn'ene // IL kn.wiedpr rtd b k/j'.! <br /> y.. <br /> (11) IVEL1. 'PESTS. YY SIGNPy /.. i d p1j�r� )y. <br /> St's well <br /> «et <br /> ITS <br /> Yea ❑ No Q If yea, br whom?_- panto WO10V 111 LW. <br /> Trrc r ten. ImnP ❑ Eedee❑ Ah hrt❑ NAME- <br /> lie <br /> AME ' <br /> M1? <br /> Death to water at sten nl teat ft. At end of roe ft tl n ted) <br /> e• wamr tam Addeea Ca�f'L� -X611! 9430 <br /> w DlxLerQe sal/m:n nfmr_Jmun neretrne • r9/7R/Al <br /> s Chemlvi andyau made? Ya ❑ Na❑ H Yv. by wit r? <br /> City 1YitT4 <br /> IV.elechie MK made? Yea❑ Nr❑ if>ea,onech eVY n,this noon -----------------Here M UV mpo n <br /> DWR-tee twaV."I-' IF ADDITIONAL SPACE IS NEEDED. USE NEXTCONSECUTIVELYNUMBERED FORM <br /> S ' <br />