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Received Dec-29-99 09 48am from 227 7600 4 AQUA SCIENCE page 5 <br /> CENTRRL DISTRICT ID 227-7600 DEC 29 '99 10 30 No 002 F 05 <br /> ORIGINAL STATS OF CALIFORNIA Do not fill In <br /> Fila with 1?WR <br /> THE RESOURCES AGENCY ��. <br /> DEPARTMENT OF WATER RESOURCES 22623 <br /> %neater of Intent Nn WATER WELL DRILLERS REPORT State well No_.._ <br /> WI a Paneth No or Dute Other Well NIAU Q t a <br /> ( 1) OWNER N,imt {12) WELL LOG, T,ttnl de th�. 1t <br /> p 57Orpth ul certnpktod well.-�fr <br /> irldress 1a h+mt It to It ForniaUan (Describe by mlm tha,n+rter Dose ter material) <br /> r +t. ;Van tec�.t __ ,itp� <br /> (?) LT1ON F W See Instructions) <br /> (,eitrth_� (Avner s Well Number iA - <br /> Il i it aaldrr- it dtfr+rent fn>nt qhn 3. <br /> T %isulcit+ _ RunKe Scotian — <br /> lRxtAiite fmm cines rands rnttri+ads fencas etc <br /> (3) TYPE OF WORKt f <br /> New We1I r, /ne-peninji [] <br /> Aecnnsiructrnn [] - <br /> 146(U S-n IQ PiRetonditioninle 0 - <br /> Nndxumal Well ❑ - <br /> DestruMture (] (Describe - <br /> destnactkrn matanuls Tr <br /> V PrcKedures to Item 12 j - <br /> (4) PROPOSED VJ ej = <br /> D+emestic <br /> lrrlRatiiut �� `❑ <br /> 11 ✓�1# ��N lndastrsal ❑ - - <br /> tst Well ❑ - <br /> q <br /> Stock Q - <br /> Munitlpel ❑WELL LOCATION SKETCH \ Other �+ ❑ - <br /> i (3) EQUIP41ENTc (a) G1�AYEL PACKr <br /> Ratan Reverse © Yee 4�(/ No 0 iz ,�91 s - <br /> Cnhle C7 Air ❑ Dievneter of bore - <br /> Other Q Bucket Q Peo)<ed from. amter i a - <br /> ("i CASING INSTAL: (g) PERFORATIONS - <br /> Steel Q Ylosuc Cerner to (I Type of pertq,-hun Dor size of screen <br /> From To Dia Gage or From To Slot - <br /> fitft In wall ft � It �" slzd - <br /> (9) WELL SEALI <br /> K pr snrfnee snnitan ital prmidedP Yes MMI,, Na ❑ If v<s tip depthft - <br /> Were strata sitAICd nxaina 11 ")OP Yes W0 N. z; lntrrcal it - <br /> Alethad rA senlm Wnrk xterttd 16 Completed 19 <br /> f IO) WATER LEVELSt WELL DRILLER'S STATEXIENT <br /> Depth of first water if knowO, �' ThLr well tmt rtrrll nder my lurfrdfetfon dpq Mrs report It Mir to the bent o) mat <br /> Standing lesel .after well iuxnpletiu _ it krww(e(fgr rued b !r <br /> f l l) WELL TESTS 8r('1E0— <br /> IYAs well tett made; Yes Nn W^It yes, by whom• (well D <br /> Tyres of taxi PIMP C3Sa [:]iler Air lift p <br /> NAl1E s <br /> Depth to water al mart of lest!• At end of test ft (Pennn arra ur orpurattnn f t TypedDor print <br /> Otscharare __„ynlitmn after hours Wear temperature Add rers <br /> h,ndaal inrl.alp init(IO Yes C, 14a Mr'�1 res, br whom" City. uP <br /> 1 ir(i 4,if made' Yes No If es utincb tip y ht this re ,rt I Ltsense 10 fi&2d e Date Of this repo - <br /> OWFt 100 tR[v 7 74, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM *Derr ssa 7 to sow au+co fQT CeP <br />