Laserfiche WebLink
TRrPLICA11 •TATE Or CALIFORNIA Uo not fill to <br /> Ownwscep'y' THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 225234 <br /> N.aice of intf,u nn __. _.__.. _ WATER WELL DRILLERS REPORT <br /> Lrrcal Permit No. or Uate_ -- State Well Nn._ --- <br /> ()that Well Nu. <br /> AO <br /> ddr Q NBCA 6bi (12) WELL LOC" s c omelet d <br /> '• Total deytiLt,'^/(L pWt}, of __.I/Y _. <br /> (:try ! Imm k. toh. Formation (Describe b color, "wt—-y. <br /> (:try ��}!' Ca.95666 r cbantrMr, sfae or rttawrld . <br /> Ip <br /> — am Ciao <br /> (2) LCLCATIQN OF,WELL (Sim initniebons): - <br /> Gwwry (.)..e$ Well Num _ <br /> Well address It different In.nt above OK 3 <br /> Tuwttehip� RanE _ • <br /> • Di fano.MAN cities, made, riLdroads, fences, etc <br /> (3) TYPE OF WORK, a,:1 <br /> New Weil:9 Di+penina ❑ <br /> flavortatructina 0 - <br /> Reconditioning ❑ _ <br /> Nnri:nnui Well ❑ _ <br /> destruction m❑iteriabe �- 1 <br /> Procedure. b Item 1p� <br /> (4) PROPOSBD bir;� <br /> Domeoic <br /> IMzatims <br /> \ ❑ <br /> - <br /> / Muni iprll r <br /> wwu LOCATION SKETCH <br /> ❑ <br /> (d► Ka[lQbSirRr (e) GRAv -BACK t <br /> Rotary Reverse ❑ Y�,❑ No� \�\•� — <br /> Cable 1 <br /> Air ❑ alf bos <br /> Otter 0 BMW ❑ _ <br /> 17i CASING INSTALLXDt <br /> S" ❑ Plaetle ❑ <br /> ` � >tipe of alt of eeftMa� - - <br /> Ftr,wt To Dia. CagaetF To <br /> k k r Wall ( k <br /> (9) WILL SEAL, <br /> Was wrtsce serkary seal Provided? Yes$ No If yes, to denH �• .,.. <br /> Wes strata aeaw a/aiaet pollutioor Yee ❑ <br /> Method at } ` <br /> ( TER M VELSf �! Work . 19 Com let l0 <br /> D"Ah ad ANN .7 WELL DR1LLER'S STATEMENTsbadjog : <br /> Mvd after wail Thk teetl was drilled ww/et ttW InrirdkNon <br /> knoteladae and thisreParT Y th <br /> true to the bast of *W <br /> (11) WELL TESTS, StcNYD <br /> Was WOR sat ,nate► Yee C] No It yes, by wbtrwr <br /> Type of M [3at Pump O Beller Air lift <br /> �, <br /> k fiD�i�111� <br /> Dep* to water ai verten <br /> of east <br /> s.1t At end of tart R NAME 11 8 <br /> Diathars— -:/tads ,Aar t+•••.. Water tem AddressY <br /> Chesaleai analyels medal yes ❑ Nu ❑ If Yee, by whnrnf City 111 110!11111732-_ <br /> Was electric log wader Yes No 1F n, anscA to,h4 re rt <br /> License Nu. _Date of this <br /> own tea Iwgv. IF ADDITIONAL SPACE IS NEEDED. USB NEXT CONSECUTIVELY NUMBERED FORM <br /> EXHISiT 2 <br />