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IDI E- Hw� ta'w - <br /> r- <br /> _ ORIGINAL srATE nr cAurownu Lo not fll in <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 163704 - <br /> s,. WAT-711 WELL DRILLERS REPORT <br /> ' L _ retie]'n-w D.ee g� 0370 r <br /> — y - other wa1 Na.0 <br /> (: ) 01Wi ER: Name /3l.(__ C/JLo /��ter•o CJ1 (12) WELL LOC: T«a er a s LLS s <br /> /G• C rtS 7' --� yN-L--fC DrorE•r!n,mofr<ad mea h <br /> Add:x.r_ ffr GrP W k f (Z _1 fmm R m h.. � a (Dn_nbe Mab:, rba.arnr. rhe n m.rcrtvl/ <br /> "S'TS!Y ;QTY Lo O/ - <br /> �. n. �sy / <br /> 1 f2) LOCATION OF WELL (Seefns"etions): - <br /> � Cman SA/v Sra.t�res. ower:. acv Nwnber - TJ - U-t <br /> — Ten rearm, a aiawm.,rmm::M,.e <br /> w,:.blp _Renee_ cerci.. <br /> J (J) TYPE OF WORK: <br /> yy' L a C/ -t Rcmmcmcrina o <br /> o <br /> � x.nwa„I men ❑ \\�\ P., ti) <br /> .(Dewnbe <br /> dnsmcnoa L .a:d <br /> ,DLJ Sac eRaqJ /Q,/J vmr.�d.,ma b lrem I:) <br /> )� S (4) FROPOSED USE-, <br /> a Ter,We:: �;/ ❑ _ _ _ <br /> WELL LOCATION SKETCH i Other - <br /> 5 <br /> :31 ECCIPNES T: (H) GRAVEL PACS: - - '-- <br /> Room •[!' Reverie O _ Yn (� Ny C Su< `( I .. . __ - <br /> C.bb ❑ A.r ❑ �. Ula.nertr of bort - - - <br /> Jcn.r (7 Hwkn J Pdtld brim-.Lm rS.i - _ <br /> 1 Ir) CAST.- -.r.STAIIED:.^�\ (tl) PERFOIIAT20N5: - - <br /> heel riuYe� Cnrc a-�. Trw d yerfnr+tloa � - - <br /> Fmes To - Ds Gate or Frain , "o Slat - <br /> fL is in. 11'.11 ft J IL size _ S <br /> (9) h£LL SEAL: y F <br /> .Pert 0a:. .SIN +telco yynmim? Yn Yi1 No ❑ Imm.L 1e - <br /> .._al d s++nn . GROUT / Wnak n• d 19— CompL. ly_ •. <br /> v <br /> (rJ) WATER ` / WELL DRILLER'S STATEMENT: Q <br /> .-- L .l firs, -.,.. . .n This ,een roe+d"W e:Wer my hs hd:srlan a.:d rhm..yon a ,me,,rhe bra of mer <br /> Surv:as =+l _". . 11ei h. k.:m.4dc. +r•�b.+/:.1. <br /> (11) V.f:d. TZSTS: S.C.._ ✓� <br /> V __. :en mea:, :"n L Na C If err. by +'Snort (W.11 Driller) <br /> Tr d.nr F—P C Have.❑ Ai, Eur❑ NASfE_��-'� G'el- <br /> Derpcsra.) (Typwl or ynmdl <br /> pu .nn b mart. ., d ae _h. AlAt e: <br /> t _ J d tear a �� 'J err ] �� (� <br /> D..rn•z -.:,my ei near W., «mymcwr_-- cr— <br /> ...dQI "-•„� a.ed., •Yn C Na P}• If rn, <br /> by -h.aa? _ cn!//vaC /:'RI L'C: o:y ?.f 2u <br /> N <br /> . _ .rhaidc N:made? Yrs ❑ No S/ IT A m arise aa,+in this renin 1 r Nn 3 >7 7 r� _D.0^f ehb report fI/-/d <br /> own iaa ;.w.vne, IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> _ CONrlDr-KnAL <br />