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<br /> STATE OF CALIFORNIA �`-' I/L Do not/;11 it,
<br /> Owner's Copy THE RESOURCES AGENCY R'
<br /> DEPARTMENT OF WATER RESOURCES No. 19199
<br /> .':Mite rd l,,trnt No. 111;kTE11 WEILL DRILLERS REPORT
<br /> Lore[1'r•,nit No.or Dme_ Sw.5l'r!I Nu�•7!J_ �/_J
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<br /> t'il!'..r•r�„�s� � .'lite`�� I r ��7 1-/ -� [�1
<br /> 2) 1.01CATIION OF N4'I:I.I, (See fmtrtrctiorss):
<br /> Crmhh'.:�IN['(r _tL�•_•_.,.�^pwarr's 55'rll 1'nrn6rr I 'F'! `�' ! q � r.�
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<br /> addrns i!dif(r, sen (n,rn aJ.
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<br /> 'fnunsl'ip Ranl:e yrs ti,.n-,.__.� __ / .I� /1:�y •� Z
<br /> llistanre Frnm cities,reads,mi(n,adr,tenser,rte.
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<br /> r'frx{ t i (3) TIFE OP IIORht
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<br /> 1 1 .i ? 'a s' }int xs ural Nelt
<br /> QCe 0
<br /> r l;'r,t�iNU.vp { -s..J 3 7t.p Desiri,etlpn�$ {Dts^nbe;ti meq'•.• .�•,`,.v -”
<br /> destrv(,tron ini7rda[s H.
<br /> �. '.-! -k.• s y, err to t pnssrdu rs In Item .•.
<br /> PROPOSED -e
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<br /> _�, s ]r Oahu •
<br /> lndostnal
<br /> ,•e ll ell ❑ _ • s
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<br /> t Stsss
<br /> IfNIT-LL LOCATION SKETCH gthrr .: b
<br /> (S) EQUIPIIE%Ts (o) GRA► PAC1Cr
<br /> Rotary ❑ Reserse ❑.. ❑.... \u St:'.
<br /> Cable [] _ Asi.. ❑ to of bore -. , i I`J'
<br /> Othri. ❑ -" --.•!_Bucket- Cal- tom -
<br /> (T) CASI\G INSTALLED - rS) FERFORA'i') .'St _
<br /> Steel❑ Plastic❑•' s t Type of pe a n xe,sf score _ -
<br /> E'rum F Dia. C:g r F \ TO -
<br /> ft. f in. IPalf fL 5 -
<br /> (0) IVELL SEAL: . _
<br /> LPas rur(aCe sanitary seal provided? )'er 11 \'n q If)es, to depth_- ,w_ft, _
<br /> Were strata scaled against pollution? Yrs(;) Vo[� Lsten•sl_�_(a _
<br /> Me"sol sr'gh g - -
<br /> ..—,�� \Tark start )g .
<br /> (IO) ►PATER I.1~VELS1 r m
<br /> Con[et �)
<br /> Depth of 9nt s.ater, If know %VELI.DRILLER'S STATEMENT:
<br /> c - 1t• This urrl srnr denied under m
<br /> tandins:1rs'r1 after well rompletInn fL L-nnrrlydgr�a/nd b i;ej v 1°r]'dirriun end Airrepuq is lure to the Lrrt of my
<br /> {I1) }YELL TESTS: 5:c�en1�L
<br /> WAS ssdl test mC.
<br /> ade? _ Yes ❑ \n❑ If+rs, by xh•nns•. � eL] -
<br /> T1-pouf test `. Pump❑ IIailrr Air lift❑ r
<br /> _S ?ler)
<br /> f� �� \r
<br /> If
<br /> nrp<� to s11r, ni ua t nt test- NAME?J1
<br /> e_ ft. At end of test Ft '"I en.n,F,rm,ur rn ,rationiljjpesl or
<br /> Discharge_..tom.-._.nal/min a;ler_`_haun - W. ` P='snlcd)
<br /> iter lernpernture Address.
<br /> Chemical-analysis made?. 1'rs 0 No❑ if yrs, by nl,onr? Ci h• �• � � r Yt;C';
<br /> tt tri trio Intl oracle? Ya❑ \'o q If srs,at,th rep.•to this report License Nu— t ` pats of this rrtsnrt.f
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<br /> ED,—I rtxv'7vat 'I F ADDITIONAL-SPACE-IS NEEBEO. USE NEXT CONSECUTIVELY NLIMBERE D FORM ss4s-ssoa.tssc auenpres.
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<br /> T�l''��� {IR��/'�f�'���. TO�.�YT
<br /> DOakENr GANN(IrBE
<br /> DUE TOT_w
<br /> }ITION OF THE ORIGINAL
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