|
K
<br />- Clave
<br />Was ..dare wnilwy red plWided? res No ❑ If res, , depth 50 ft•
<br />o
<br />- 320 G rave
<br />"'ere stmt- settled oydnrt Pollwlon) I'm ❑ No ❑ lntenal ft.
<br />M
<br />- C
<br />?icth,d of ",J!.•
<br />a cont nue o♦
<br />(I0) RATER LEVELSt ..
<br />(
<br />JPLICATE
<br />oTATC Or C-ALI IOn NIA
<br />DHILLL•'11'S STATEMENT:
<br />Sl:mdine level filer web e.,eplrtinn
<br />p,
<br />comply with
<br />THE RESOURCES AGENCY
<br />/
<br />SIf.Slin /If '/ •!i �' �. /' ' �/�//, '• ),
<br />')`)
<br />requirements
<br />DEPARTMENT OF WATER RESOURCES
<br />No, 1.4282
<br />14282
<br />;,doll„IrntN,,.
<br />\NATER WELL DRILLERS
<br />REPORT
<br />City s lOUe9t0} CII.-
<br />]acd \'lint No. or Dnl
<br />.%ip_gS350-
<br />_. GiO,..
<br />-.NF'Srs �nw r. -s. IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONS ECUTI\H ',_,,;OEpgp
<br />SIMM
<br />Olhr, Well
<br />(1) OWNER: N,,, Par Country Estates
<br />Ox
<br />(12) tvI:LL Loc: - �]
<br />tut Ji„IIC.25 _Il Depth '•I re,,,, Irinl /J/
<br />AJdms
<br />Cil)' -�
<br />�•'
<br />• • l3
<br />Irma fl. b, fl.
<br />writ
<br />F.,nml, -, lDneriLr by 04,.r. chAriteler, I,,. nr mnlerfnl)
<br />zip—
<br />-
<br />PO
<br />& vel
<br />(2) LC>b('.i•I��OI YELL (Sec instructions):
<br />�+++ 9Y s+�•�+�+
<br />- 2
<br />Sand
<br />iso”
<br />C.....
<br />Oa nrh W,11,\ nn,he,
<br />12 - 1
<br />sand .&
<br />ave
<br />\Pell vddress IMet Ilene, above
<br />'11' S
<br />1 -
<br />Grave
<br />'rua•nsl,i„ natty
<br />srru�
<br />siia
<br />sy
<br />.
<br />DisLnm fore, cities, mads, r.ilmads, fences, etc •—
<br />vest
<br />-
<br />gave
<br />of. olt coursa C
<br />_
<br />ay
<br />–Nor eas
<br />ec on
<br />(3) TYPE OF NVOHA,
<br />6 =
<br />`. Qla &
<br />vel
<br />New well Denanioc ❑
<br />G el
<br />�.
<br />Recn1. Mole, ❑
<br />BeamditlnNnp ❑
<br />6
<br />^
<br />-
<br />Gravel
<br />Rnriblmd R'e)1 ❑
<br />-
<br />Cla
<br />UrslmMinn ❑ rials old
<br />drn e,nirridI and
<br />_
<br />2
<br />Gravel
<br />d.im
<br />Penred UeM In lie. 1_n)
<br />2 - - 0
<br />Cgravel
<br />(4) PROPOSED USE:
<br />O -
<br />Gravel
<br />1h,me.Ii` ❑
<br />-
<br />C a
<br />Irriyntiun ❑
<br />-
<br />rave
<br />6 - 12
<br />Cla &
<br />ravel streaks \`
<br />Tell Well ❑
<br />12 - 1 0
<br />Gravel
<br />svwk . ❑
<br />130 - 1
<br />Gravel
<br />& clay
<br />a,lmiri„d
<br />1 -
<br />Gravel
<br />WELL LOCATION SKETCII Other ❑
<br />_ tittifl
<br />(S) EQUIPMENT: T
<br />It"Inn' ❑ Brrrrsr
<br />(d) GRAVEL PACK:
<br />X birdseye
<br />-
<br />Gravel
<br />g
<br />Gshlr ❑ Air ❑*
<br />yrs \n ❑ 5!
<br />Dialei fb.m
<br />-
<br />ay
<br />p
<br />grave
<br />-220
<br />Luay
<br />Other ❑ Bucket ❑
<br />Packed fmn, O to t.
<br />-eeo
<br />uravell
<br />(T) CASINO INSTALLED:' •,
<br />(B) PERFORATIONS:
<br />22 2 12
<br />SIVA Mollie ❑ Gmr,i 0
<br />Type uI nrrfurntinn ,, .ixc of .crei,o
<br />2 - 2
<br />G v
<br />From TO Dia.
<br />CRge or
<br />From - To Slot
<br />2 - 2
<br />C
<br />fL fill. . In.
<br />WRII
<br />ft. ft. size
<br />2 - 2
<br />Gravel
<br />–
<br />- 0
<br />Cla
<br />0 - 0
<br />ClaY &
<br />92TVel streaks
<br />- 1
<br />Gra 1
<br />(0) %VrLL SEAL) y
<br />- Clave
<br />Was ..dare wnilwy red plWided? res No ❑ If res, , depth 50 ft•
<br />o
<br />- 320 G rave
<br />"'ere stmt- settled oydnrt Pollwlon) I'm ❑ No ❑ lntenal ft.
<br />M
<br />- C
<br />?icth,d of ",J!.•
<br />a cont nue o♦
<br />(I0) RATER LEVELSt ..
<br />(
<br />\Fust .Inner —Id_.�.)0--
<br />tl'ELL
<br />Depth of first .voter, if knn.
<br />DHILLL•'11'S STATEMENT:
<br />Sl:mdine level filer web e.,eplrtinn
<br />p,
<br />T'hir i nor rhilkd under -: ....... lir,i�m rn rl J,i.,' nr,,,rt i.v Inrt to the Ara of my
<br />knnudrdyr and IlyIf I. i
<br />(11) 1VELL TESTS)
<br />/
<br />SIf.Slin /If '/ •!i �' �. /' ' �/�//, '• ),
<br />W." .,It test ...ade? I'es � Nn ❑ If .as, by .'h.nn?
<br />T)pc of lest
<br />/r,
<br />(Nell
<br />Pum,
<br />I en`Ir: ° "`` het p
<br />U"J.. to mntre nl start .1 tea[ %11: At s•ud �d•leil 1�,
<br />D J,vr)
<br />vA�Ie Iiennines 5ros, Drilling Co. Inc.
<br />y, 11
<br />DI.Jia+Cr 2. j:,0.min ni)cr h�nv. '\\'.lel Irmprrnh,n•
<br />114..�m, !. )gni „r sinlnl
<br />:1J,Lrsg2g5_Pdanoa e�.��Fe�. 1 1
<br />Chrmirnl anal)'»s nmdr7 Yen N
<br />G o� I( )rs, by s,'hnn?
<br />N'... :
<br />City s lOUe9t0} CII.-
<br />•n. L.¢ maJr? )"AlNn a II )r., m;.uh h, Ih i...... W.
<br />.%ip_gS350-
<br />_. GiO,..
<br />-.NF'Srs �nw r. -s. IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONS ECUTI\H ',_,,;OEpgp
<br />ELY r -
<br />LA
<br />
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