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Do Not Fill In
<br /> STATE OF CALfFOANIA
<br /> THE RESOURCES AGENCY B T U 99773 n"7 7 3
<br /> DUPLICATE DEPARTMENT OF WATER RESOURCES 1�I J J / J
<br /> Retaln this eoPY State Well No.---
<br /> Other
<br /> WATER WELL DRILLFRS REPORT ''''..�r 11�,,
<br /> Other Well No.�2A}{ —
<br /> (1) OWNER: �(1 1) WELL LOG:
<br /> Nameantec
<br /> • `h"LL•
<br /> �—_]3 Ei ' ' { r t l a •,I Inn n urn+h er rnn,rinrJ.dl r,.
<br /> Address P .1 nom. r;� rnrm nrrrrd.by
<br /> (2) LOCATION O WELL: 1 r'
<br /> Cuum,.
<br /> 0.—"
<br /> ro ,be if in,
<br /> T.—h,r.R,nRr.,and S,,,—n t` e'ru' M i��5r7 43
<br /> Ununre cram ruin,road 1,nilrn+Ja,serer: nom}T _• -• �,��.66 �n IZ,:i
<br /> ���
<br /> (3) TYPE OF WORK (c ec ): —
<br /> Nev Well R Deepening ❑ Reconditinning ❑ Deun,ying ❑ - � ' 1on C
<br /> fj destruction,describe midirridl and pruredrrrr in/lrrt I I. ,a—i�o ^nrjd
<br /> (h) PROPOSED USE (cheek): (s) EQUIPMENT — f` 141 "I -
<br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary
<br /> Irrigation ❑ Test Well ❑ Other( Cable ❑ t t n ���} ^��7 —
<br /> f 9 r P r ^ Ini Other ❑ _--
<br /> (6) CASING INSTALLED: I _ —
<br /> X OTHER:
<br /> If gravel packed
<br /> STEEL:
<br /> SINGLE M DOUBLE❑ ---
<br /> I !;agc Di.metcr I
<br /> }'run, fo nr of Prom •f o -
<br /> ft. It. Dim. wall Bore ft. ft.
<br /> n rr
<br /> \., •I,,:e +ell r {i, o,. .rl• 1- _. __
<br /> 11rw r,l.r 1.7 ri - —
<br /> (7) PERFORATIONS OR SCREEN:
<br /> Ilrr of faatur.u,o,urn of, + ��
<br /> I'erf. Row•t
<br /> I•r.nn '1-u rcr per Sire .
<br /> It. ftrow ft.
<br /> --fir}-- -�*�. •�;�---
<br /> (x) CONSTRUC11ON:
<br /> w_. „ri,.r, nl Mw,Jed% 1';,�, ♦,: - -r::.Lr dei.,;. fie} �r�—'—
<br /> w r +Ird, u r.,ll - �:. -• Ir deer ..r., I —� _
<br /> r..m .__ 1• f• -+—r, rd r r, 74 .romrinrJ Iv _
<br /> Vr.1�•J:n•„Lnr [t, r•"_,- _ I �C•i l.l. DRII.IJ.It'� STMT-11:NT:
<br /> � Tl:, err(! n:, ,Irdlul rnr.lrr it pr.ndu•lipn and lbia rrr4nrl i, htu• to the bell
<br /> (1) WATER LEVELS: •.f estl 1:,,,,tri,,lr,a".l Ahe.f
<br /> (IU) WELL TESTS: dr t.1s«_ CJ,� l,,•nhl n '
<br /> I mer ,., ` --- 'i, __.,., u�. --.'`•--_—.---�-----1' ( ,
<br /> N,,, 9w't-
<br /> 55!<ETC:H LOCATION OF `AELL ON REVERSE 510F
<br />
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