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<br /> QUADRUPLICATE I
<br /> I Use to comply Wath STATE OF CALIFORNIA Do not fJl in
<br /> fecal requirements THE RESOURCES AGENCY
<br /> DEPARTMENT OF WATER RESOURCES Not 055338
<br /> \•{". nl Intent\,r._-- ' �, WATER WELL DRILLERS REPORT
<br /> Irreal Permit Xo rw Date'_ State Well Xu._ _--
<br /> Other Well\r..
<br /> i (1) OWNER: v..n..-- ---- -- --- —
<br /> AAdrete, ' !12) WELL L(X::
<br /> Tr,f.d Arlrth h Depth rd—pletrd
<br /> -.-._-/�--J 't % / __ -_-_-- Inrn tt, hr h. F,,m.tirrn ,Dev rile M- adr a, .hzinkter. the or material)
<br /> 13) LOCATION, OF WELL ( •instntcfinnt—V7ip`J ( - r �,
<br /> (}w•tlei. \t ell\llml,er.___ _ J - � '7 r,A �./ !r_�.
<br /> %%.n rddr.it dnlerelrt tnm.
<br /> Tr•wtnMp_���: ce. J _
<br /> .- .-___Ran - �- r - /• '/ •I•r,•r -of
<br /> /+r
<br /> awls•railn.rli,•fenrea,eh.- - /. ri.
<br /> (31 TYPE OF
<br /> /.+ t-,.; .• C1.µ- - .
<br /> \'ew Well D-I,nm¢ - •r' �,J� J .
<br /> I Ilnnmtal tt'ell (� _ - 1
<br /> Ih.t 1..rn Uh•tl•rihe \� _
<br /> 1 dr.tnu.rilrn mrlenrh WIII
<br /> pnrrlan. In 11"' 1• _ �•
<br /> j 01 (1) PROPOSED -
<br /> Il•rnre.til \ _
<br /> i tr j Iiriv.tirml _
<br /> 1 ' - Cj
<br /> �`\\
<br /> } TrV i
<br /> O ,
<br /> 1t'ell -
<br /> L
<br /> ' senna i N _
<br /> "11.1. LOCATIOY SKFT('ll Other n
<br /> i i 1 Eoclr%te�T,
<br /> in) CRAB PACKI --
<br /> ` I
<br /> Nufrn D hr•wrne ❑ Vu %IMS;..
<br /> I CrhM .{`j .tar O�\ \\
<br /> t _ r.rl Serle-----'"�" -- -- --- -
<br /> (Rher rJ
<br /> j 17• CANING IYSTAI.I.F.D 1N
<br /> O] ra
<br /> i"PFKFORATI %1 _
<br /> Steel Plrn<• ❑ (:. r,Ir•••1,rrt(fi�lhrn edea•d amen
<br /> Fr/rllt •ra— 1 Dia• Ca or FITr1/1. ' To Sit -
<br /> ft. 14 m ft �� (t. .ixr• --
<br /> 181 WEI.I. SEAL. _ --
<br /> that .urfrar tnnrtan ted hnrvldral• tet ❑ \r.,�: If}et, br Jeph _ .. h. _ '--_- i '
<br /> \1'«n• •tr do YaInI al'AIMt Iwtlutr rn! Yr, [J Vo�; Inlrn nl.. ._ _ q -
<br /> Neth,d rd terhnl�.•---- - -- - tt,.l)t ,t.rnr.l._ _
<br /> 1 Sol WATER LEVELS. ��1:1.1, IM11.LF11;S S1'ATI-MEVI
<br /> D.,rth ref Intl ,ate.. rt ►r.,.n -- _
<br /> ._-_-.__.�-. _ ._ _ /1 111 rt Irr11 Y.•r rlrr•Ilvl Mrrl•r
<br /> 1/ nen/.r• w r Irrnrtrr aur-r wad Ihn
<br /> NI-1
<br /> nTrrn .. IrN. In IM Ilr,l .r/ wry
<br /> alr.hne 4,e1 alfrt re111rn1� r4fe.n 4rr� wwd Lt6.1
<br /> + i l I WELL TEST%t
<br /> M., aril M.t m,.1e• 1.. \ 11 1, «h rr.• - - "\t rte Ihdhe, -— -- ---"
<br /> I,Ir. ..I Ie.t !'nmp Rwdrr \.r I,1•
<br /> 1•yrth h• ,rrM1 .lar1 d Ir•.1. h tr .rel •1 1..1 r I hr r, - --- - -- -�--�-��- '
<br /> n. Orr.•.. •.r..7«r rb m r T.Ird•w pnMrrll '--__
<br /> l t.r h..rc••. -_.. _ _vat mm .Ir.r .. _.M•.rn N.rM nn.,...,r•.n -. f {'LIQ•• - __ _ _ .. _ -_.__ _ _ _ 1
<br /> t h.,nr.al .rnwl,.r. rnrtr� t.•. \. i 11 .... 1-, wh...,r. ` t t.. - - - _. - - - _- %rlr..
<br /> N. r l_in. I a .rM• 1.- ) ♦, I• .tl.r h r rnr. ..1. I ._r... \,. -
<br /> OAR Intl rev 1 •+ IF ADDITIONAL %PACE IS NEEOro i1gE NF.%- CONSrCUTIVELY NUMBERED FORM
<br />
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