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`k <br /> ORIGINAC STATE OF CALIFORNIA Do not fiU mn <br /> ft THE RESOURCES AGENCY n� <br /> He with DWR DEPARTMENT OF WATER RESOURCES Na, 185786 <br /> of Intsmt 1\0WATER WELL DRILLERS REPORT Stats Well NO <br /> rant Na ar nal Other wall]Baal SN+ b � ir <br /> (1) OWNER. Nutria- 1 (12) WELL LOG: Total daprsr �t Depth of omnpleted wa1L Ft <br /> + s ' <br /> Address From ft: to ft l:owmatiars (Deacnbe by color, character mini or mat"al} <br /> Citi, - <br /> (2) LCICATION O WELL (sea Instnlctinrta) - <br /> Cauz<tY tltQy Ownees Well Num r - <br /> ti <br /> Well addrans If iffereot from aba <br /> Township aug � e <br /> .Distance from citt roadm,mUroa+]ar fetitee,at.,Aw <br /> � \�\ <br /> (s) TYPE OF WORxt <br /> Now 'WoRX neepanmg Q <br /> Reoomtractfan ❑ <br /> Reeanditsotung 0 - Y <br /> -Horizontal Well ❑ <br /> Destrmctron 0 (Desenbe <br /> \y aastnXtfonNAtP.rfah ,f <br /> 1 ,,gyp procedures i )t. l ^, <br /> (4) PROPOSED` ZA `}I\ <br /> —14V7 V Domestic <br /> Industrial CI <br /> p <br /> Well '� ❑ <br /> yV,v � StockN 9 <br /> WELL LOCATION SKETCH thar <br /> (S) EQUIPMENT �(a) <br /> )lob7ry ❑ Reverse © Yea No <br /> Cable ❑ Art ❑ r of hom 4 <br /> Other Bakes [7 'Pec),Ce* - <br /> 17) CASING n+rS'i�� {8)�f'>3�+Vs �� — <br /> Steel Ylastfo eta Type at p a =o of screa7k l <br /> From Tg Die, Gdo or Fta ►� i To }'3fa `a <br /> fk fe i ixi Wsii ft. f <br /> r.. <br /> (0) WELL SEALt \� <br /> Wes surface sanitary snot pmv]ded? Yes No ❑ If Yes,to daptlLIM <br /> � _ !t <br /> Were strata sealed against 7 Y No ❑ Iv • <br /> Medved of see ode a[ast 1rJ Camp ]9 <br /> (1()) WATER LEVELS t WELL DRILLER 5 STATEMENT <br /> Depth of first water, ff kno 1rs This trait was aced rumw ma JuArdfeifon and thin report if true to the beat of My <br /> Standing level after well comnlat>oo_ ti V fc �nOtoiedSo F8f <br /> (11) WELL TEST5t S] <br /> War well test made? Xaa O No4 H yes, by whorl ell Driller)) <br /> Thm of test Pump ❑ Sailor❑ Air Ilft❑ NAME • • "''0� <br /> Depth to water at start of _!t At and of tort Ft � Ponen,firm or c ) ( � or printed) <br /> Wlt- <br /> �gal/rofa eR� hours Water tamper Ad <br /> analysis made? Yes 13No ❑ IF Yea, by whmaie log made? Yes❑ No L7 ]f Yes,attach cagy w this ratwrt I+icer+se N � ZZ& to of this <br /> wR 16e ("V Yawl IF ADDITIONAL.SPACE 18 NEEI?ED, USE Nr=XT CONsSI±CUTIVEL.,Y NUMBERED FORM <br />