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Received Dec-29-99 09 48am from 227 7600 --) AQUA SCIENCE page 7 <br /> CENTRRL DISTRICT ID 227-7600 DEC 29 '99 10 33 No 002 P 07 <br /> STATE OR CAUPOANIA <br /> ORIGINAL THIS J928OURCIIS AO6NCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCE O O <br /> WATER WELL DRILLERS REPORT No. <br /> f o otire of Intent No. State Well No, <br /> Local Perinit Na or Date 232 q( ( Other Well No <br /> (I) OWNER Name 1 (12) WELL LOG Total dq,1h 230 It Completed depth ft <br /> ktldn from ft to ft Formation(Descnbt by color chara0cr size or matorial) <br /> City� �� s,A *, ZIF r S <br /> (2) LOCATION OF WELL( ee trtstructions <br /> ) <br /> Crttlnly ) Owrsrr s Wei)Nlinther - <br /> Wet l address if different from above _ <br /> Townshtp �€1i�,TF:G�Range Section <br /> Distance from cities roads railroads,Fences,etc - <br /> CL Ahj\e <br /> (a) TYPE OF WORK <br /> New Well X Deepening ❑ ' <br /> Reconstruction ❑ <br /> Reconditioning ❑ e <Ial f-I CL A <br /> +� Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> 1� destruction materials and pro- h <br /> ! cedures in Item 12) r J <br /> 1 (4) PROPOSED US _ ) <br /> Domestic <br /> Irrigation <br /> Industrial ❑ e _ ,� <br /> Test Well ❑ <br /> Municiboo <br /> • r er <br /> WELL LOCATION SKETCH 'be) <br /> (e) EQUIPMENT &CRAV}��1(K <br /> Rolary �- Reverse ❑ Na Si:'e,1 <br /> Cable <br /> ❑ Air © et of bore p� � <br /> Other ❑ Huck ed rum <br /> 17) CASING INSTALLLD? (g) PE T! _ <br /> Steel Plastic Ela Ty of artusivad U _ <br /> From D Gagge or lzot — <br /> ftf WaIE t size <br /> v — <br /> (9) WELL SEAL <br /> Wu surface sanitary ant provided? Yes , No ❑ 11 yes to depth 2i7 it. - <br /> Were strata seoled against pollutiqq0l, Yea ❑ No 1l Interval (I - <br /> htelhalo[sealtny ) - WorkstiirteJ FL 4 I Com iZt lA <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known - Tss� El Kiidi4tianStanding level after wall completion ft Thss frn u-n ndrr astd Chis rrlHxt iY rue l0 11tB <br /> !seat of mil re ed�Q andBe <br /> (11) W ELL TESTS �,r Signed <br /> Vas well lest made? Yes C3 No No If yes,b whom? ( a r er) <br /> t p,rd I"I Pump ❑ Bailer Atr lift ❑ NAME <br /> a pth to water at start of teat It At end d teat ft t. ( ar tion)(TfIk4l or pr ted) <br /> Ree <br /> DIKAisixe Kat/min after hours Watestemperatury Address <br /> Chemical analysts made? Yas ❑ No 4 If yea,by whom? City ZIP e <br /> Was etscsriel made Yes ❑ Nom If yeap attach copy 10this repo" L,icenae N0. Date of this report / <br /> DWR tat!tRXV t3 eat IF ADDIMONAL SPACE 19 F46YDSM 1J88 NILXT CONaECUTIVOLY NVMBURRD FORM � Sys <br />