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$TATE Or CAUCOr,Nin <br /> TRIPLICATE TME RESOURCES AGENCY DO Itpf (i(1 111 <br /> Owner's COPY DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 256450 <br /> tilatr Wsll No. <br /> Local Yennit No or nate 0111rr Wcll No. <br /> 1 ) OWNTF.R. Narn• cityof RID= (121VdF.L1. Li)C: 'c.,:d d,ol. R ('„mfdrtcd deplin <br /> Addrrsn 1�1{'fie O n 6 (rnm ft. to 1t. Fornimirn iUr.�rilxx be color. character, d-e Or malrliall <br /> ninon California z.1r <br /> (^_i I.i ” "PIONOF WELL (See instructions): - <br /> 15 S and <br /> 1'ounay San Joaquin Owners Nell Nmn).w!r <br /> N'rl! adder,.if differrnl frim abo,'! <br /> -I'mrn<hlp R,111go Scrtinn - <br /> lllumve from cities. roada. rnilrvads. Fences, etc. 0 - <br /> 70 <br /> r^ 11 ll venue 70 - 71 <br /> d <br /> Bob, 1 <br /> .'r ts't•ll I% l ,•I�'niliQ ❑ - 1 Gravel <br /> nrcrmarnetlo„ A�\ <br /> - 12 la <br /> Itrrnnd:umm�r 12 and <br /> Iioriznnul Well - 27 Quy <br /> O ,:.� d <br /> f1mmictlnn malHiniq and c 'ures in Item In_1 \\J' S ,�(4) PROPOSED US - - <br /> Drrmc;tic J _ 44 9 <br /> ]rrigalinnq 2 Z <br /> lu,hnlr''^l O ❑ 1 _\ 197 eH Gravel <br /> era tt'rI1 <br /> Clay <br /> Municipal\ ❑ _ QSand <br /> L I rr \\\V\ > - <br /> WELL t.xn <br /> Aoz elf <br /> 'S: rw1im!ENT GRAV ACK <br /> „r. reavrr J I Nn _ soSend <br /> f=' .� \ <br /> i.ab1.. ❑ Air r_'I er rt Mrc u -- - 4 <br /> 1 Clay <br /> n•... ❑ Rock ,. ed 4w. - <br /> TIv: 2 _ <br /> $Lv{ I_ Plssre ❑ r Ty of Ir tn,or size of 2 Q 1 <br /> Gagcnr ) of 2 - 2 Sand <br /> Wall t. size1 Q - 271 clay <br /> 2 - s <br /> v - <br /> (9) WFI.L SEAL: - <br /> N•y.orlemsanitarvsnlPmvidrd° yes ❑ No D It yC.!o Depth It. — <br /> Vcr..q.ar:gale{ncalnst gIIW im,' 1'en ❑ N,, ❑ Inlcrvol It. <br /> Mr�inJ,{.;;,line Work aartFd l5m lemplctcd 19 <br /> lu: \\WrEli LEVELS WELL, DRILLL•'R•S S1'A'lEMENT. <br /> fYp,i,nl Nra.va!rr. (knn.n <br /> i <br /> This ¢rfl'pras 11'(11.4 emm <br /> ir• u, pu,1�q tn+), titu} 1tLs rc <br /> .t )x+t ii rl r»u• In :hr <br /> aenAme 4.'rl,rn•..rll ron.pl!+-�, ft Inst of tog krf6*-dav and(relief. <br /> (1 1) WF.I.I. TFSI"S: <br /> Signed � �.�•�• <br /> ❑ No ❑ If yn by„.IM,,,7 :Wal Drp Irrl <br /> T.v�{,aa Pnmp ❑ D+IIcT r Airlift r. N1,ME Clark Well & glAm@T1Tr QO I Tnc . <br /> prplh l••,.ater aatan e(lr.t_- 11 1e rr,d nhrsr <br /> ft fFr:» lin r,m •ralloN(T pedor FitNedi <br /> Addrrsa 20213 Easy G�tiar°�er tflV <br /> pw.lc•:- eel/min aL•rr.�- kw:r. w',vnrmprnmr a.y <br /> Na ❑ Il pn br,vhnm' (:ill St0(:ktOn s C,.rtl Z" i Q Q <br /> Chrni<ei aralnif nuJF' Yr ❑ X21 560 h <br /> w,.+•�r�rr!c lcc made 1Y- i-3 No ❑ 1t•e,anaeh cop.an lhi.npr,rf Lirenve Nrt I]ate of tis rrpnrl <br /> IF ADDITIONAL SPACE IS NEEDED. VSE NEXT CONSECUTIVELY NUMBERED FORM „y W: <br />