|
GUADRUFLICATE
<br /> Uss tc comply wlfh STATE OF CALII'ORNIA Do NU!fill in
<br /> local requirements THE RESOURCES AGENCY ^I
<br /> DEPARTMENT OF WATER RESOURCES NO. 061473;,'
<br /> .N"Iice.d Intent.,,.__ WATER WELL DRILLERS REPORT tilAta.\ven Nn.
<br /> 114 Penult so.or Ont'. (kh \\'ell Nn.
<br /> (1) OWNER: Name__�1'!9✓ �_. (12) WELL LOG: Tntnl dep e _ft Depth of complete,!well; 50 It.
<br /> frnm ft. to ft. Formntion (1'.eecrihe�hY—mMr, rhxnoter, .1'e IT mxtr•inl)
<br /> ( OCATIO OF WELL
<br /> 2) L
<br /> Cun nty�Li!y__ / //V (See inslntctiuns):
<br /> N Owner's\Vrll l:nmhcr - ..�•"���/./
<br /> w• 41.,R,...
<br /> \Vrll address if different frnm nhnve_ __ K
<br /> Towmhlp„�__�Hance__ Srrlion r! -/o/• rcr _y-` 1
<br /> Uirtnncd(arm rlfirs, xds,rnllm.dc,fcncrs,rtc. �
<br /> >e r D r}L,'_ ell _
<br /> (3) TYP���������E//////���OF 1VORK:
<br /> ,e
<br /> Ne \l'rI1J�; Deel,enin¢ ❑ r •A
<br /> Itrconrl nr//cf lnn p -
<br /> HecnndllinnlnK ❑ ) - !O �,� .a A�: -
<br /> �
<br /> Ilnriznntnl \Crll p �� FN RN /
<br /> dent n,w 1s mntrriAlh
<br /> e pf�1
<br /> ��.---- --- prncrdrrin oa �Y -
<br /> (4) ROPOSET) 71 %
<br /> / D,meeti, / - -
<br /> (f/ Indust rixl \\v 1
<br /> T•.
<br /> \tunic yu -�j
<br /> \\'F.LL LOCATION SKF TCII Otho / ❑ -
<br /> .',S) EQUIPMENT: (0) C. L\YACKr J - -
<br /> Hnh,ry�6 Ilrvenr ❑ ', \ Nn� /Slgr` _�^ �\ �..� _
<br /> /I V
<br /> [nhlr C Air ❑ r,4•r of hum _ - / ":,t r
<br /> (hl.r. ,.:1 Rnel4cl ❑ corn n S'' - !'•� - __ _
<br /> (i) CASING INST�A(LLF:U: (ti) PERFORA'MI�i�6':
<br /> Steel ❑ Plaatl✓U Co e Tyne of IC4nr
<br /> FrnmT_ r F �J To
<br /> ...
<br /> (9) �VELL SEAL:
<br /> \\'ns mrfncr snnitx rY aeal prnided? Yr. ❑ Nn ❑ If
<br /> \\'e n• arab, arnl<.1 nCninrl pnlhdinn:+ �'rc ✓-1 Vn [” Inlrn•id� fl.
<br /> (In) 1VATER LEVELS: %YELL DHILLEIVS STATEMENT:
<br /> Del,th ..f hal water, ii knm,, ft Thi, well trrn ddilrrl Ynris;,my,MrI.dicti,n and rrpurt n In a lu fhc hr+t of mq "
<br /> StmnHng le,rl nfu•r „rll as+mplrlim, — � � .
<br /> (11) WELL TESTS:
<br /> \t na 11 lrat mud«? .Yea ❑ N.^Q"'1ti~)ea, by wham° 1/\\•Il Driller) .
<br /> Tvlx,nl.te.t Pnrnp r+ Hxilrr p Air alt p NAME _ 1.L'L�r(.a,.
<br /> Urpth L. wnlrr 1 1 tca_�.___II. AZ end 1-1Iral__�Il ��.> (. n�,flrn r vorl Alyn)
<br /> DlachAr¢r_ ., >,n I'mlu n fier___)....... \\'nra•r IrmprraUvr _ ,ldd rraa
<br /> Chrrnlrnd nnnq,i, made? Ye, C' Nn ❑ If rrr, by wham?._. _.. Cit)'—.�'-T�T__�---��` —--__.%•p` n✓-�..__
<br /> i~ _J/ale of lhl,
<br /> N'na rlevt rlr Inc .n:.d«° 1'r> ❑ No ❑ II ,ra. ntlaah c•+p. !n Ihi. n'n..n :.ira nar Nn,�..l�t1� --_
<br /> DWR !e9 incV. 7.1e. IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSEZUTIVELY NUMBERED FORM
<br /> I
<br /> I
<br />
|