Laserfiche WebLink
I <br />' 0o iNAI. _ STATZ OF CALIFORNIA Do not fill t 4n <br /> THE RESOURCES AGENCY <br /> 1e with DWR DEPARTMENT OF WATER RESOURCES 1110- 185790 <br /> of Iaaant N WATER WELL DRILLERS REPORT sty wen No <br />' No arlZat Otter Wets No ntilltJf Ed13,1� <br /> (1) OWNER. Name <br /> - (12) WELL LOG: sotat&w& <br />' 1 O � ft W g A (De.cbe br —I-, ehemets� -I- or mat-W) <br /> c;tr <br /> (2) LOCATION�,�F WELL (see susbuctwm) <br /> ,dw Q _Owaeea wen N.4.A \` <br />' <br /> wen addrres if £s+om alq r <br /> TOwasht ` <br /> ]]t—ftrAi taiee PAM <br />' (3) TYPE OF WCLBKI ` <br /> New Weald DeW--g ❑ c <br /> -RV•J Aaaondrudicn E] — ` ' �r <br /> 1 M1 _ 4Y <br /> Iferit Walt ❑ <br /> � [2 WexcrMe <br /> efatN7ials ! <br /> pmCGdlYle iR hens l�? <br /> (4) PROPOSED'T931♦n — '\`;'�; �!1 ��• } <br /> `cl, <br /> Imlvsafat � Q '� �� <br /> 1 <br /> won <br /> Jti <br /> 7��f�tCATTON <br /> Sl=tR '_� r — �' �;��'.� �,• <br /> - <br /> Rotat7+ ❑ nevasse ❑ 5` Yea�+ Na-o {'_ <br /> Air <br /> Other <br /> Q ❑ <br /> $ted u I't awo Emis❑ Ty"of of <br /> From To—ti D. 6Q&e r MIA'. `�.' TO <br /> ft f��V m. Wan fC, ft <br /> (g) WELL. SEALt <br /> Was mzdvA Marr seal pamdedP Tes.A No ❑ If res,to — <br /> we= strata sealed sammt 1 y No E3 +` . 00 <br /> Xttbod of adc <br /> (10) WA TEB i.EVEi.St WELL DMLLER'S STATEMENT <br /> U*Ih of But watts if lsaa m u wa tMad Wu%j ay funw atim and thin report is Ifte to Rhe bm of mg <br /> Stam levet aftw won cam <br /> (11) WM.L Tms• s <br /> was wen teat moan? Yea ❑ No I% If rM by wtv=P 4 W ) <br /> T"a of teat Pmnp ❑ tisna t3 Ar Uft a N <br /> Day& to wale: at sa.t of tom_—___R At and of <br /> pIlmin water Add <br /> enalyais made? Yes ❑ No ❑ if Yas, by wha®4 Qm <br /> kc made? Yes❑ No Q u res.almah—W'm toss l ramose N Sr of tLda <br /> 13WR lea (RW 7.7et IF ADDITIONAL.SPACE: 15 NEEDED USE NEXT CONSEGUTIVMY NUMBERED FORM <br />