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.'.^ <br /> -.''!Ash:Aar+.a.:.�.. .. _•_•..__�___. ._....."•' .. .. <br /> 02 <br /> ORIGINAL STATE OF CALIFORNIA O no ill in' •� �' ' <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 09 410.6 <br /> Notice of lntmt No. WATE WELL DRILLERS REPORT Stat Well he7777 <br /> Luca;Permit No.or Date— . <br /> y I Gthc.Well No._ <br /> (1) OA ER: Name (12) WELL LOG: Total dep .Dvpth at eDtttpt�ad:in k , <br /> a <br /> Address- /ram It. to k. Formatlon ( by Dolor, chate <br /> racr ftq�er <br /> ky <br /> � Cry— ty <br /> Y _ <br /> 3 <br /> (2),L A,TI IF e ELI+ (See instructions): _ <br /> Cnun Owner's Well Number <br /> f <br /> Well address if diff(/.,from ve <br /> i Towmhip - ]flan Secti � ^ <br /> B <br /> Distarsee fm cities, a railroad fe s,ctc <br /> r ... 91S 7— <br /> I <br /> (3) TYPE OF WORK: <br /> r <br /> $ - New Well (x Drepenlnq❑ — *- <br /> W Reconditioning <br /> Horizontal Well ❑ _ - G: <br /> Destn[etion ❑ (Describe <br /> deveyrinn in material <br /> prsxeures Item 1 — <br /> QZ <br /> (4) PROPOSED 1& - - <br /> Domestic — <br /> Irrigation�\ }' <br /> T Well�� ❑ — .+^cam <br /> n Sto <br /> t s <br /> } - Municty — <br /> WELL-LOCATION SKETCH Other ❑ � <br /> (S) EQUIPMENT: (6) CM PACL: - <br /> Rotary s�❑,,� Reye— 13 ❑ No Size <br /> ,L* Cable l� Air . ❑ er of bore <br /> Other !❑- Bucket ❑ <br /> (7) CASINC INSTALLED: (87 ERFORA 'S: 1l <br /> S[srol PWtic ❑ Type of ye o or e of sc <br /> From ' To Dia. G r F <br /> To <br /> fL ft in. Wall ft. <br /> (9) WELL SEAL: Y <br /> Was surface sanitary seal Provided? Yes ❑ No If 1'es, to depth h12 <br /> . — � <br /> Were strata sealed agaitsst pollution? Yes Q !Sn ❑ Interval ft. — it I <br /> Ti'' W.,k started 19 ComDlet l9 s r <br /> Mrthod of —Lia .r <br /> (10) WATER LEVELS: WELL DRIL ER'S STATEMENT: <br /> ft, This II w drilled u my iur{rdictioc and fhfs- n it true to the berK <br /> Depth of first water, if ksso <br /> s: h. knowledge h<iid. '9a <br /> Smnding level aha[well com Dletio — �# <br /> SICKED <br /> (11) WELL TESTS: Wd e } ' <br /> IV- well test made? Yes No [,' If yen, by whom? lift Air - <br /> Type <br /> rtf tat Pump fXr) Bailer❑ ❑ NAM f .: <br /> r a[ art of totftAt end f test <br /> em— . o (t s(Ycrsn or ration) (T or yri 7 <br /> De h o Add— <br /> Du ail/min :after hours Nater temperature_ - ` <br /> Chrmirn] anlysis made? Yee C No If yes, by whom? City <br /> a <br /> %I,.,electric lag made? Yea ❑ <br /> No If nes, attach asps t"this reyttrt Licer>;n Nn Dote of this to Po <br /> OWR tee (REV.7.7e) IF ADDIT ONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> dnF <br /> r' <br />