|
I t
<br />R �
<br />QUADRUPLICATE
<br />Use to comply with STATE OF CALIFORNIA Do not (ll in
<br />local requirements THE RESOURCES AGENCY
<br />DEPARTMENT OF WATER RESOURCES No. 142825
<br />N,ni,e of Intent Na. WATER WELL DRILLERS REPORT
<br />State Well Nam
<br />Local Permit No, or Dote -
<br />Other Wall Nn._�,�111,j6:_
<br />(1) OWNER: Nmn Par Cou Estates (12) WELL LOG: T11=nnddeptl737fLnenm.rferrmnleted •all737n.
<br />Addre, • • in I ft. to ft. Formation (Desrrtirc by c+.:n, vhn rnrt f, siren material)
<br />Cit, BCy, ,ip con ua ge o.
<br />(2) LO%TJWJUMLL (Stv luxtrnt•lions):
<br />County Owrleix Well Nanlber _
<br />\Veil address if different frnnl above
<br />Toueuhi, Range Seelion --�
<br />Oislana+ inrm cities• mad; railroads, fences• etc —
<br />y
<br />(10) \NATER LEVELS: WEA -1, DIiILL1:R'S STATE:\11iN'I':
<br />Oepth n( first cr i( Anru'r fl. Thi., uv/I ons d.ilird oral... nnr .Sri+rlirri:m and Nri+
<br />SI:unline Irrri afte•r m'eIl conrplelion _ II, knmr (r•Agr rmd h,ha. o-ln•re r. rnu br Ilu• Irrnr rd orp
<br />( 11) WELL TESTS: - sluxi — _
<br />lest made? vc,i ❑ -o, ❑ If yes, by m'hoor?
<br />�_
<br />n89 Drjjjj=
<br />.I Pan" ❑ ,&filer ❑ Air "ft ❑ NAME Ha- 8 B O
<br />'1'.'a• of lexl
<br />IN."th la m'n1C, a slnrt of teeL It. At Sad ul IdlII I'•.m It M, 1,
<br />K2 p( asu �pomliurU ('rYlrnl or prinlnil
<br />Diudmme vnl/min after hnun \Yale, tempenino — AJdrarr_�u�P�IL�pp • B�f/�Wa1� Ayo._,_
<br />Ch.....hal nnab'si, made? Yes ❑ No ❑ If yes, by wb:ml? Cio.—HSyPs/.s7�.Q�Ys�4 rA
<br />\1'..e vintrio laLL uuule? 1•es ❑ No [-1 If vee, nitm'h 1 Lr Ihir n•Iort_ l.hea,iv No._ 299 .1
<br />DWR lee rarv. 7.741 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
<br />Wz+ -u2tai
<br />,travel
<br />Q C.La streaxs
<br />(3) TYPE OF WORK:
<br />-
<br />New Well ❑ aeelleei.R ❑
<br />-
<br />s a
<br />ave
<br />Re,comtme6un ❑
<br />-
<br />r clay
<br />1lenm1litfmdnK ❑
<br />-
<br />urave.1
<br />llodznntnl well ❑
<br />_
<br />a
<br />DeAntetion ❑ (Ihserihe
<br />material, and
<br />-
<br />ravel
<br />a(: ay 8 res
<br />Pced=destmctinn
<br />a in Item 12)
<br />_
<br />ay
<br />ss
<br />(4) PROPOSED USE:
<br />-
<br />1).m,oatle ❑
<br />_
<br />lrriantion ❑
<br />_
<br />IMIIIFIr111I ❑
<br />_
<br />Test Well ❑
<br />_
<br />Sb.k ❑
<br />Municipal ❑
<br />-
<br />WELL LOCATION SKETC7(6)CRAVEL
<br />❑
<br />_
<br />—
<br />f3) EQUIPMENT:
<br />ltoesn' ❑ Ite,erso ❑
<br />Cab&• ❑ Air ❑
<br />Bucket ❑
<br />tn B,
<br />--
<br />_
<br />t; 1 CASING INSTALLED,
<br />(B) PERFORATIONS,
<br />--------
<br />-
<br />Steel ❑ I'Imlie• ❑ Concrete ❑
<br />Type of Per(amtion or size of semen
<br />-
<br />Frrnn To Dia.
<br />Gtge or
<br />From To Slot
<br />-
<br />ft. fl. in.
<br />Wall
<br />ft. ft. Am
<br />_
<br />-----
<br />(J) WELL SEAL:
<br />_ - --
<br />--
<br />—
<br />\Cas sudnre snnitarr seal pnrridnll Y"
<br />D Nu ❑ If g'rs. W r4•Vth' _It.
<br />-
<br />_
<br />\\'an .dnrtu venlat nColmt I li:nion7
<br />Ys•i Cl Na ❑ lnlorvnl-
<br />T--
<br />tictla id of sndin,
<br />1
<br />R'orA sturte4_ �
<br />_IB
<br />Gnaplt•led----14.___.
<br />_
<br />(10) \NATER LEVELS: WEA -1, DIiILL1:R'S STATE:\11iN'I':
<br />Oepth n( first cr i( Anru'r fl. Thi., uv/I ons d.ilird oral... nnr .Sri+rlirri:m and Nri+
<br />SI:unline Irrri afte•r m'eIl conrplelion _ II, knmr (r•Agr rmd h,ha. o-ln•re r. rnu br Ilu• Irrnr rd orp
<br />( 11) WELL TESTS: - sluxi — _
<br />lest made? vc,i ❑ -o, ❑ If yes, by m'hoor?
<br />�_
<br />n89 Drjjjj=
<br />.I Pan" ❑ ,&filer ❑ Air "ft ❑ NAME Ha- 8 B O
<br />'1'.'a• of lexl
<br />IN."th la m'n1C, a slnrt of teeL It. At Sad ul IdlII I'•.m It M, 1,
<br />K2 p( asu �pomliurU ('rYlrnl or prinlnil
<br />Diudmme vnl/min after hnun \Yale, tempenino — AJdrarr_�u�P�IL�pp • B�f/�Wa1� Ayo._,_
<br />Ch.....hal nnab'si, made? Yes ❑ No ❑ If yes, by wb:ml? Cio.—HSyPs/.s7�.Q�Ys�4 rA
<br />\1'..e vintrio laLL uuule? 1•es ❑ No [-1 If vee, nitm'h 1 Lr Ihir n•Iort_ l.hea,iv No._ 299 .1
<br />DWR lee rarv. 7.741 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
<br />
|