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DUPLICATE STATE OF CALIFORNIA <br /> Driller's CO THE RESOURCES AGENCY <br /> Copy DEPARTMENT OF WATER RESOURCES DO not fill in <br /> WATER WELL DRILLERS REPORT <br /> Notice of Intent Nn. No. 323825 <br /> Local Permit No, or Date — $rJ <br /> (1) OWNER: Name 'fd�L L-AA-1 U 7-7-e tl-- Ot lite' Well No. ---- - <br /> Address 3 (tet/ jv (12) WELL LOG: Trial de thti�J <br /> P (t. Completed depth ft. <br /> City �J/�� from fL to ft. Formation(Describe by color, charate <br /> cr,siz <br /> C . e or material) <br /> (2) LOCATION OF WELL (See instructions): R _ <br /> County <br /> Well address if different from above Owner's Well Number <br /> Township Ran <br /> ge Section -7/ <br /> _ <br /> Distance From cities, roads, milruRa fences,etc. 4P Ir- <br /> 4!, <br /> (3) TYPE. OF WORK: /4/�L — <br /> New Well Deepening ❑ <br /> Reconstruction ❑ — <br /> R <br /> Reconditioning ❑ /�'(� S+ d <br /> Horizon(-] Well ❑ / _ X.<LC <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) �. O <br /> (4) PROPOSED US Zf <br /> Domestic ri — s <br /> Irrigation <br /> Industrial O ❑ <br /> Test Well El — <br /> Munici ❑ <br /> or — Q <br /> WELL LOCATION SKETCH ibe) _ <br /> (5) EQUIPMENT — <br /> CRAV <br /> flMary CK: <br /> Reverse ❑ — I <br /> NO Si <br /> ❑ <br /> Cable Air ❑ <br /> et of bore <br /> Other ❑ Back <br /> cd lromt <br /> (7) CASING INSTALLED: (S) PE _ <br /> ATI <br /> Steel . I <br /> ❑ Plastic n c Ty of (o fiat or size°( <br /> From D' Cage or <br /> ft. f I. Wall of — <br /> 1L L size _ <br /> 1 — <br /> EAL:W(9) WELL SEAL- <br /> Was surfac,sant-rYse-lprwided? <br /> assurfacosanitarysealprwided? Yes <br /> Wens strata sealed against pollution? y� No ❑ If yes,to depth OJ <br /> Method of sealing ccnl< V No ❑ Interval (t. <br /> — <br /> (10) WATER LEVELS: Work sturtedly_ <br /> Depth of(first water,if known_ ss <br /> WELL DRILLER'S STATL•'MENT,rr I feted n 19 <br /> Standing level after well mmpleuon f t' <br /> This well was drilled under ra jurisdiction and this report Mtrue to the <br /> TESTS: <br /> (11) WELL f0 best of my knowledge d fief <br /> Was well test made? <br /> Type of test Pump ' ND ❑ Ifyes,bywhom? CJ/—T/t_ Signed z <br /> Pump Ej❑ �Iv� / //A ztJ/1Z J S r(Well <br /> Dnikr) <br /> Depth Ioat <br /> wer at start of teat Railer EJ!l. Airlift lA/cr NAME <br /> Discharg e y s At end of test (l II a�qrc <br /> gal/aim.fter_ hours �,) �O•ryLfl //7 porauon)(Typed or printed) <br /> Water temperature Address <br /> Chemical analysismade? Yrs ❑ No Ne Hymbywhom? / /2./L/y� <br /> Was electric log made Yes ❑ No City ( o � 1 C <br /> If yea,attach copy to this report _ 7.1 P <br /> XTCONSECUTIVELY NUMBERED <br /> own tee(REV. t2-Be) IF ADDITIONAL SPACE IS NEEDED, USE NEXT FORM <br /> Dale of this"p,""p,"MnDENTIf.�,1 86 .:ils <br />