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QUADRUPLICATE .TAT[ OF CALIFORNIA
<br />Use to comply with. Do not ill LI
<br />P i hTHE RESOURCES AGENCY
<br />-
<br />localrequirements DEPARTMENT OF WATER RESOURCES No. 142830
<br />Notiee 111 Intent Nm. WATER WELL DRILLERS REPORT stote Well No.
<br />Grnl Permit No. or Date Other Well No,[ -
<br />(1) OWNER: Narn. Par Country Estates () OG: 12 WELL L%3%h 73
<br />P.O.Teed depth
<br />Addrer VDepth of eonlplet,4 .,If It.
<br />frvnn ft, to ft. PonnnNon (Dererihe L dor charnel ria. r
<br />• • neon m. P R•rinD
<br />(2) LQCATTr OF ELL (Set- instructions):
<br />Cnunty- n d O8 Olnmiz \Vett N.....
<br />\fell xddrem if different (moil.6,ee
<br />Tu..uship ItangC Serlian_
<br />fiialxlleC imlll t'hICS• mild(• IIIIIM1IIIdX• (enLCX• Cle.
<br />3 w - j 7
<br />Orave1
<br />\\'u. aoln.e znnilxn' s•nl prv•eidnl7
<br />1'r. ❑ N” �,1) If y .. m depth ft.
<br />`I
<br />'--�'?�—T♦'as�—_—
<br />(...�- .{
<br />3`1�
<br />i` 1r -70
<br />nl7 1'e, ❑ N.: -,
<br />1
<br />SI,`Ih:xl of xealine
<br />_
<br />( 10) WATER LEVELS;
<br />(3) TYPE OF {YORK:
<br />New Well ElDee""Itot
<br />nM„n.emen„n
<br />neooadilinning
<br />Ihrrt..o4nl \Vrll
<br />Deideo Bell ❑ (Describe
<br />dezlnetion noltadnt, and
<br />po.edures I„ Item In_)-
<br />(d) PROPOSED USC;
<br />D.noeslir
<br />trrizoiva
<br />6ulnstrinl
<br />'1'ozl Toll
<br />kl.... ir "A
<br />Other
<br />n
<br />❑
<br />❑
<br />❑
<br />❑
<br />❑
<br />El
<br />❑
<br />n
<br />❑
<br />- �-{�r
<br />-
<br />-
<br />ll'1•:LI, DIi11,Lh:H :ti S'rA'I'h:\11?\'I':
<br />- rave
<br />I to Pth ,�I Ilm ,anlor, if kw•v o,
<br />�i.:nJ
<br />_
<br />,III a dnlh .I nnd•`r m. n"I•.li�ro:: :nod tlli,
<br />Gravel--
<br />me Ir,r4 u14`r we•11 , ugdrtinr�__�y^ 111.
<br />y
<br />- re -
<br />-----
<br />---
<br />_
<br />_
<br />--
<br />Wnn well tem made? Yos L,\•.
<br />y
<br />- rave
<br />n:f;,e, ❑ Airlet a
<br />WELL LOCATION SKETOf
<br />D I Ih 1l t t l t I Iret—_.
<br />05) EQUIPMENT:
<br />Ihmin❑ Ikvrrze ❑
<br />Cxhlc ❑ Air ❑
<br />00o, ❑ if k,t ❑
<br />(f) GRAVEL PACK:
<br />1't. ❑ Nil ❑ Slee.----.
<br />Dioolcte1 of Ion. -
<br />Paektrt fnn,l t„ _ft.
<br />..Ine.tJ ---
<br />rnCll
<br />_
<br />. \o, yro _
<br />-
<br />7 .)
<br />_Hoaestot-�• -
<br />-
<br />I ttth ,,
<br />. ]
<br />C ,
<br />L u v:`. hr ..lout '-- _
<br />- c•
<br />1,-9535x_..
<br />I,) C.1SINC, INSTALLED:
<br />S,,.el ❑ I'I:rolir ❑ Cuncre4• ;
<br />(8) PERFORATIONS:
<br />'I'„w of perl,oallul, ....lee
<br />^- _
<br />la: • w . 290613.. ` .
<br />D bI th r......
<br />-
<br />_
<br />FI'nttl ro Din. G:tq” of
<br />ft. ft. in, WAl
<br />From lo slot
<br />ft. ft. S;zc
<br />rave C y
<br />_—
<br />-
<br />y
<br />—
<br />y
<br />-
<br />-
<br />rave
<br />1
<br />—
<br />rave
<br />y —
<br />_
<br />I J) {YELL 5EAI•;-
<br />�FPurOIL
<br />—
<br />\\'u. aoln.e znnilxn' s•nl prv•eidnl7
<br />1'r. ❑ N” �,1) If y .. m depth ft.
<br />`I
<br />'--�'?�—T♦'as�—_—
<br />1Cen• Arta seaMl ngnI... t pnnuln
<br />nl7 1'e, ❑ N.: -,
<br />y�'r,i
<br />SI,`Ih:xl of xealine
<br />_
<br />( 10) WATER LEVELS;
<br />----�—
<br />\1'nrk xlurinl_,.___-___In.
<br />ll'1•:LI, DIi11,Lh:H :ti S'rA'I'h:\11?\'I':
<br />I to Pth ,�I Ilm ,anlor, if kw•v o,
<br />�i.:nJ
<br />,III a dnlh .I nnd•`r m. n"I•.li�ro:: :nod tlli,
<br />me Ir,r4 u14`r we•11 , ugdrtinr�__�y^ 111.
<br />A,molydp:` mu! h:•, /. .rl'•:rr
<br />,r nur p: Inv In•N If rup
<br />(II) WE1.1. TESTS:
<br />Wnn well tem made? Yos L,\•.
<br />❑ — --
<br />,,,x` •.f nem p u
<br />n:f;,e, ❑ Airlet a
<br />Na{1KenningsBros, Drill) nrt
<br />D I Ih 1l t t l t I Iret—_.
<br />' - •{At eyl ; I !t
<br />3521y14mlyral, r rvil
<br />..Ine.tJ ---
<br />rnCll
<br />"1111011".
<br />. \o, yro _
<br />-
<br />7 .)
<br />_Hoaestot-�• -
<br />I ttth ,,
<br />. ]
<br />C ,
<br />L u v:`. hr ..lout '-- _
<br />,. n _
<br />-- -
<br />1,-9535x_..
<br />\l .: lutrie ,� n mb. ,'ve
<br />N _ p._ purl
<br />^- _
<br />la: • w . 290613.. ` .
<br />D bI th r......
<br />-
<br />_
<br />rI WR 188 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
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