Laserfiche WebLink
CENTRRL DIS <br /> —fRICT ID :227-7600 MHY Lti 'y`1 r:O� N0 .UU1 r .Ui <br /> STATE OF CALIFORNIA Do not jiU in <br /> UGINAL THE RESOURCES AGENCY <br /> DEPART'JENT OF WATER RESOURCES No. 163558 <br /> e with DwR WATERT WELL DRILLERS REPORT <br /> State Well No. <br /> ,:f intent NI d / Other Wel)No.7 f O Ln COZ <br /> ?omit No. <br /> or V"n <br /> (12) WELL LOG: Total depth R.Depth of completed welv,204;. <br /> I\ OVVNEi}1: Nam from ft to ft. Formation (Dercnbe by color, chancier, size or material) <br /> Id rca Zip <br /> tr TI 0 WEAL (Secinstmetions): - <br /> S) L N ��. Owoe/s Well NumberAel - <br /> ountr fn.bore <br /> "ell eddron if diaoreaRange S...tM <br /> uwoshlDihhc.ds,farms,Mc <br /> Ihtance/roan ciJtleAr, <br /> Rall. - <br /> 011W (3) TYPE OF WORxr 11 <br /> Y i' ' NNew Well (ming ❑ <br /> !' O Itecnvrtn .v ❑ - <br /> Reconditioning <br /> dm ❑ - <br /> Nonul Well ❑ - <br /> t[r�J dertrvctlov 0 (D. ud <br /> r <br /> moov& In Item 12) <br /> (4) PROPOSED USE, <br /> Uomndc <br /> tit y r <br /> Imitation ❑ <br /> f dustrial ❑ <br /> Toot Well ❑ <br /> Suck ❑ <br /> M.nir;o.l ❑ opt-It,brand fax transmittal memo 7 Y of papa. . <br /> `) µ.ELL DATION SKETCH Other ❑ <br /> TO from <br /> (9) GRAVEL PACKI CO. <br /> Is) EQUIPMENT' Yes ❑ No ❑ Sve <br /> peverse ❑ DNPt. Phone I ^ <br /> Rotary t� Air (:) Di.roeu 'r of bon / 3 <br /> Cable ❑ socket ❑ Pockedf Fe1N /� �/'1 PF.rN <br /> Other ❑ p, (g) PERFORATIONS, <br /> (7) CASING INS <br /> TAL7�Caocrte ❑ Type of PmfonNoo m 910.1 screen <br /> steel Yle'uc ❑ FAN GWeBed1 or From To Slot _ <br /> ft <br /> From ft. Jn ft size <br /> _ <br /> ft. It <br /> Y <br /> l9) WELL SSA•' ywlaeaP Ya f9--1+• ❑ 1t ran.m a.prh�Jt. <br /> IWer sud.ee ser"a"Y WI en poautbnP r t'3�6 ❑ Iete a1 h. - <br /> Were dnta wiled r Work 19 ConPln 19 <br /> Method of realm �'S, WELL DRILLERS STATEMENT: <br /> I (30) WATER LE This <br /> i of all .,ddd nder my fudsAictbo and Chir report u to to the ben of env <br /> Iy,p�h e( ant W.ler, if pPlet <br /> I" rNer wsU SiCI iEP-e V -'�'��— <br /> Suvdinl ,/ (Well Driller) <br /> (11) WEI L •TESTS' Ya ❑ If r.. by whom" �i/��ly C �/1�6IJ <br /> Bailer ❑ Air utt NAM <br /> Wet well ten wade PwpP ❑ R At end of ten rt ( S,m,m oorpontlev) ( ped or Printed) <br /> Type of tint d of tdt----� / Q' -`* ,,nn <br /> avh tp water N rr/� eftm Duro Wear tanpen Cddroes P� <br /> „r11 �. ` .Y ' <br /> Yea ❑ No !I�" Yin. by wTom} of WY repo <br /> u <br /> mads Yes ❑ No Imes. attach copy to 6", npon Licevre N <br /> y .ts <br /> Wu eleclde MO m.,leP <br /> IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED "ORM <br /> DWR teff lnrv.Tnn <br /> 1 <br />