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QUADRUPLICATE <br /> STATE OF CALIFORNIA Do not R in <br /> comply Useseto comp)y with <br /> w <br /> local requirementsTHE RESOURCES AGENCY <br /> DEXRTMENT OF WATER RESOURCES NO. 3449'3 <br /> ,ti,a of Intent No.�gq�q� WATER WELL DRILLERS REPORT State Well No <br /> Grcal Permit No. or Date 77---2'-- pqs�77-201W Other Well No. <br /> (1) OWNER: Nam- ka�c ltz (12) WELL LOG: Tntal a e'���_,_�,,(,��[� Depth of enmpleted weu�ft. <br /> Addmsome ree Road from ft. to k. Formation (Desc be by color, characteq size nr mate'n`a57 <br /> City VtiCa 7' <br /> 1 3 top soil <br /> (2) LOCATION OF WELL (See instructions): 5 hardpan <br /> County Owners Well Namher { <br /> %VeR address if different from abeve <br /> Township Range TSD Sectio <br /> Distance fromcities, roads,railroads,fences,etc. <br /> 64 Bes <br /> (3) TYPE OF WORK: <br /> New Well Deepening ❑ <br /> Recon.¢tnsction ❑ <br /> .__...__. .� Reconditioning ❑ — <br /> Horizontal Well ❑ <br /> i S DesWction ❑ (Describe — <br /> f 1 <br /> pdroesredMures mIeri <br /> — <br /> ' (4) PROPOSED - <br /> Domestic <br /> � irrigatio <br /> IndIuw �. <br /> t Wall ❑ _ <br /> S <br /> WM Mart <br /> lay <br /> ELL LOCATION SKETCH Other ❑ elfty <br /> (5) EQUIPMENT: (8) GM - <br /> Rotery ❑ Reverie ❑ 11No S' - <br /> Cable I Air ❑ r of bore <br /> Other ❑ Bucket ❑ ro _ u <br /> d Sand <br /> (7) CASING INSTALL£ (8 PERFO S: hard brittle My <br /> Steel at Plastic ❑ Type of n o tae of a — <br /> black sand <br /> Fwm T Dia. r To proper well sc,x!- <br /> as itustatte <br /> ft. in. Wall ft, s- - °` <br /> 7 easing. <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If yes, ht depth a, <br /> Were strata sealed against pmilution? Yes ❑ No ❑ Interval It — <br /> Method of tire Work ata 19 Cemplet 19 <br /> (10) WATER LEVELS: WELL DRILL R'S STATEMENT: <br /> Depth of first water, if know It This well wes drilled ..isr my itin diction and this remit is true to the best of my <br /> Standing level after well cocepletio k. knowled&e end belief. <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No,❑ If yes, by whom? (W-B Driller) <br /> Type of test Pump ❑ -Batter ❑ Air lift ❑ NAME <br /> Depth W water at start of test_ ft. At end of t k PanfMn, n - u printed) <br /> Discharge__. oat/min after.-------hours Water tempera Address — _ <br /> Chemical mmlvsis made? Yea ❑ No ❑ if yes, by whom? Citysocallon <br /> Was electric log made? Yes ❑ No ❑ If yes, attach:copy d:this aspect Liceme No. of this repo l.laT <br /> DWR 188 (REV.7-7ei 'IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM ,s.nso v-rs sow euwo«azo <br />