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� t <br /> 41JAMPLICATE STATE.Or CALIFORNIA <br /> Use of comply with THE RESOURCES AGENCY 1�' Do not fill in <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 174600 <br /> t ItHr„t . NV VI I;R WELL DRILLERS REPORT <br /> M Dal. <br /> SrxM\\'ell Nn._ <br /> I OWNER: ........ u y-Lr,f f (12) WELL LOG: �( r <br /> r,.... T••tnl drMh2_U f• IMt•th•.1 a..mpMwl well ��.�. <br /> 1d•In••• .__ _- - _e!r C 2 S• ,,r rt,r Inmt ft. n. ft. r,.m-1-n 1 larunhr by ardor• ahanrtr,. Ire „r matenAll <br /> to-- rtf,r�_Ci /rn Ll <br /> t <br /> 21 LOCATION OF WELL 1 titr ih�tn:r ht nI. �C 'y <br /> (:••ooh L r ��I►��__-_-Owner.\l ell Numhrr. --_-__ % ^C r(1 <br /> %%'ell xddrear if dlNrtrn•Inmt ab•,er--�_---. _ ---_._-_-� 35 - Z17 C I 'y <br /> T-Tvhip R:arCr - _ Se,te.n _ LZ - 102 S L n d <br /> Diata.tae from<ihn, nada,rarin,a�l•,len,.•a,,ti._ _ ^! i -a j. f <br /> t'Rl127 <br /> �ce ---- - - -- r.- -Clay <br /> 131- 290 <br /> --- '' - C <br /> — Z - A <br /> (3) TYPE OF WORK, - <br /> I \rw Well IkepenlnQ ❑ <br /> ' I1—ndtti.mina ^ <br /> 11•.nr,•nta1 %%'ell ❑ <br /> Ik.t#ncti-.n C IDew nhe <br /> draln.(Iwn material• and <br /> prmel.1ti- in Item 121, <br /> 1.1) PROPOSED USE# - <br /> I>vranha <br /> Irna.ttmn ❑ _ <br /> Inlminxl ❑ -- <br /> Test %%'ell O - <br /> %t•.it n - <br /> ' 11oM,gsnl ❑ <br /> WELL [.()CATION SKETCH lhbrr ❑ <br /> t.S1 EQtI?W%TI 19) G11AVKI. FACKi S.�r%( f - <br /> a <br /> dIleverte Q 1•rt cy %',,[3 Sloe. - r <br /> f1.4an �h A <br /> (Lhlr r.: Air U plantMM of N-tr <br /> l hher O <br /> III.her Pntn1 Inn', <br /> CASING INSTAI.LEDt R t PI:RFOt1.lT10N8t - V <br /> �er.l ❑ 1'laatic („� Gsk tare LN Tt1w••I prr(-tratitm of alar rtl wmen - - <br /> Fntttt I'o Uia. (+#Ig or l n)nl Tot Slut .. Vii;/1L l N <br /> It. (t. iu. \fall Lt. It, size - _ ' <br /> (g) WELL SEALI <br /> ttatailaD <br /> seal prn\illedl Tt'(7i \n if ora• to dryHh_ xjy�.�It. <br /> \%'aa anAatr - <br /> ...rrr xrxm.r r••rA.e►w► 1'r•(i 1., Intrnal.._- __._It. <br /> Nrth•rl wd rarabnr- =1.- _. _ -- --- W-A Nan v ' _ _HI 'r _ Complelyd _lO <br /> (10) WATER LEVELSt WELL DRILLER'S STATE%fEKT: <br /> lkyah M hr.t watet. {f k#wtw', _— - -- h• This w4l wu drill"!ander my tunadirtkm and this rrtwrt is Irre re IM bow of my <br /> tita�sline lrarl .dtrr well cnmpM•U,tn_____,__-- --- -- - <br /> krIowirdRe and Owhd. <br /> (11) NVEL.L TESTS: SIC.Nm <br /> i •- (� II se.. ha wh,rtt1__� (R'ril Unllert <br /> \\'as well tral ntnde'. 1'ra 1.; \o _ 1 1 -, <br /> Tare .d test 1'ongt [ Ifulrr 1 Air lill 0—-NAME— <br /> 4411: <br /> to -.%ter nt .tort nl teat -u >\t e',d ..1 rot-_ h 11'ennn• nn,or corrutrathrrtl I pr,ped ar pnMM) <br /> Addr"s 3r2r rel etI Al,F <br /> IHat]tarQe RAI!min :tltrr boon 1\',Her trmrtrrnhtrc <br /> AXE- <br /> Che-a-sannlass nxde? Yrcity r-—r- <br /> - <br /> C <br /> Llcrnae\o„ C• ---Date..I thh rcry,n SJ <br /> \%'n•••Ir.Ms' b.a mode? \'r• 1) \n .� 11_`r._'H u h .,pt t•.Ihn n•Lto <br /> AODITIO—wNAI-SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> DwA 166 111ty T.Tat IF <br />