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<br /> -'•' TATE OF CALIFORNIA No. 1 V O1 •7L
<br /> MIaPLICATE THE RE50UytCES AGENCY
<br /> owner's COPY DEPARTMENT OF WATER RESOURCES
<br /> WATER Wri—L DRIL.L�I S RI;!'OIi I %,j,••rH�' N
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<br /> OWNER:
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<br /> ��•;) \ami - -
<br /> Addre,s
<br /> ( ) LO(;ATLON 01' WELL (S[•�instructiu,:, ): � g� 8��s �—
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<br /> C..rrnr,.�r!-a70 1 �"•"T } tp-c �J+--._- _ acted' iota odor —n
<br /> `T iat V coarsl�irre
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<br /> railn,ud+,irnsr;,etc.
<br /> 1]istvur Emrn cities,nada, - � C3dOZ' ��-
<br /> 18.0- 24-0
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<br /> (3) TYPE OF
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<br /> 1\•E:LL LOCATION sKETCkI to t_1 43 -
<br /> IR) GRAVF:I:.PAC - F _
<br /> EIS EQUlYS1ENT: \rr�J Sixr.._ n '�:'- _
<br /> Hn•ene
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<br /> ]surlert p P:eilnl•Frnm-��t�—
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<br /> (7i CASING ItiSi'ALLED:{(,--��
<br /> Cane ret`r. ! ,ertnridun car�tpr nl careen.
<br /> steel 13 Plaati •ro
<br /> Dia. Ca)a or FMIF ft.
<br /> nau Tor' wall ft.
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<br /> (y} �1'ELI. $ hr, p lE)r's,o-,drsnh�i _ Iy
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<br /> cal rr•]im:.. - 'VLLL DRIE: and thin report rs trot u,ehr br
<br /> btr`Unxl El. -
<br /> �VATER LEVELS: Thi, cit nap d;llyd and r m!r _ J
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<br /> c ,disc lr•r3 .[,,-r wril wmPlrtu, Y—_ - ..: �..
<br /> f]S) \VELL TESTS: N,. IE )n, h.. whnr"?� KAVE T ,ed car Pnntn/
<br /> Yr+C Air hR D (Yrnc.n,hem,car Curtx„atfgn) I St
<br /> 1Cas well t.•s, uncdr? )•cem1, a Sndrt L k, f��. -
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<br /> . L'1"r,niral psah,l. ucadr? Yr. N„ [I>r,.xtt a,h a I.t'u.lhfr rcPnrt _ UME3ER E6 FORM
<br /> rin,nr h•c mmir? 1'rs U NEXT CPNS£CUTIVELY 1E
<br /> t 15 NEEDED. USE
<br /> uNFt JOB rnrw T° IF A13DITIONAL SPACE
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