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_ .:_ „ ... .. .. 'r ,,.. .1 :,. s`rs:"1 � awye ps ss v:vs rr.Aw'P.t..a1...`.....,a'•`nr.�..a.r�r.n•s�::av's1.M:�L.iY.iss's:aac:a..... <br /> n s <br /> S <br /> v� <br /> QUADRUPLICATE <br /> co ply W STATI:OF CALIFORNIA Do not fill in <br /> local r quire with <br /> local t�oqulremants THE RESOURCES AGENCY ��• �gs► 9�6 <br /> DEPARTMENT OF WATER RESOURCES <br /> xotk<of Intent\o. _ `VATER NVELL DRILLERS REPORT Wrll.N„ <br /> Lrcal Prnnit No.m Date Other Well No. <br /> (1) OWNER: , Qt= ~ander Moulen (12) WELL LOC: Tf.l depth 596ft. Depth n1 r.mtpletni weIljblr. <br /> Address- 202x3'1. 1 y-enA � q III— ft. h, ft. Forma nn (Describe by odor. character, size or material) <br /> City C8 DOs • Zip +C20 - C so <br /> (2) LO O�o jL (Ste inisstenrlctionc): <br /> ay <br /> G..tY- %%vll Numher <br /> nd <br /> _ <br /> S I Well addres+if different from above aT <br /> Tuwm•hip _Rance eecti.n - LD J6 <br /> 1 <br /> Di, ruc fmm cities,rrasds, 'Inrads f -es,Kc 0 son Oa - <br /> North o� trveearig t2 <br /> ILV <br /> 140 56 2 sand and Ls7 or 9 of <br /> }� (3) TYPE OF WORK: - <br /> •'� New well ' Deepening❑ 0 <br /> t a Rn..mtmction ❑ - ^ • <br /> and lmand <br /> Aeaonditkming ❑ <br /> Ibrrirontal Well ❑ _ n <br /> I"♦i. ��/ Detructir�n m (LrscriFe <br /> destructo - <br /> �J <br /> ,..� <br /> �\ prucedum in <br /> n <br /> (d) PROPOSED :r t <br /> l' 11 31 own r <br /> J7omesticfizave- <br /> % ~fly 1 <br /> eli <br /> c `Yr 1^ \ �� Imcatiun< r. Ras 74t <br /> `J I Irxiustrial <�� ❑ <br /> T%"" <br /> � ❑ - streaks of fnd <br /> SS - <br /> t \YELL LOCATION SAETCH Other s L7 360 <br /> - S <br /> (s) EQUIPVE\T: (e) ctuv Acr: 3 - 4 Cla Gard <br /> Rotary Ft—, e ❑ • ❑ So �� Siz � and and _J gravel. L <br /> I <br /> C hle Air ❑ r of bore - Packed sand soca! brittle <br /> "'• Other D "IIncket ❑ mm ,�2._—h - CUT <br /> •(7) CASING INSTALLED: \ (8) PERFORATI l - 4and and ink clay - I <br /> Steel 119 Plastic ❑ ('.n a Type of pe a of scree - J;Irrits ! clayI <br /> a From To Dia. Gt r F T. <br /> - - band brittle C 1 ' <br /> it. f Wall ft. ft syxc - 0 Sand <br /> and and clay layers <br /> 2 1G z - an I <br /> 'i (g) WELL SEAL: S —properwi cover. was --it—all-40 C!1 <br /> wasa face sanitaq•­1 provided? Yes ❑ No l* If yes, w depth ft. thL -we r.sam not respona t <br /> ..,a \Sere strata sealed against Iwl:utioo? Yes ❑ No (`9 ]ntcrval ft. <br /> for any alrarM or r"51 of riza <br /> Method n( -*Lro, \L' 19 <br /> (101 WATER LEVELS: WELL DRILLER'S STATEMENT- <br /> Depth of first water, if know It. iarisdictkm eil this report is tare in the best o/ my <br /> This ta'rU uat driilyd uruler my IM � <br /> Stamling Irvel after wel —roplet,o. It. kwwledce-end hell/. <br /> (11) WELL TESTS: SIGNED " �•. l �•Was well test Ina,le? Yes ❑ No If Yes, by wham? _ (WeR Driller) A,= <br /> Type of test Pump ❑ Sailer Q Air lift['j NAME Paaaro WOU Drilling; +ro <br /> Depth to water at start of test.—ft. At end of tent ft 3 u td) <br /> Disctiarre Qal/min after hours Water trmpe nt,"__ Address <br /> OW ��, Cattfo 9:53151 <br /> (7sernical analysis made? Yes [• No❑ If yes. by whom?_ Ctty 44 111:-1-OLA. <br /> -W <br /> Was electric ks[made? Yes ❑ So ❑ If ers,attach copy to this report License No. Date of this report P <br /> DWR 188 (PKV.7.78) " IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> f <br />