Laserfiche WebLink
r <br /> STATE Of CALIFORNIA • <br /> MIGINAl THE RESOURCES AGENCY Do not fill :n $$$ <br /> Fite With L?Y1IR DEPARTMENT OF WATER RESOURCES <br /> WATER 'JELL DRILLER REPORT No. 305053 <br /> -? BOG' <br /> Notice c:Intent No.`, / 6 State Well Na <br /> sly Local Permit No.or Date. LL�/J �a l _— "3 Other Well Na <br /> (1) OWNER: Name � (12) WELL LOC: Total depth 6X—ft.Completed depth fc <br /> $ E (DescribeSb ng $ <br /> Address m FruIt. to (t. Form tion(Describe cobr,chaer,sift or mataiali <br /> city ;e,e�- z1P <br /> (2) LOCA�T�/O�N F WE/L/L,,(�S//ee instructions): — <br /> Count'% i 15IA/ dcL!�Owner's Well Numbe - <br /> f _ <br /> Well address different from shove� Z ` � r <br /> Townsh(p!/Tn�� _Rang Section - <br /> Distance f om cities,roads,rafiroads.fences,a c. - P <br /> �.� -.1G✓ a O - 190 <br /> f C <br /> (9) TYPE OF WORK: _ <br /> New Well oDes'pening C3 1 60 ML3��10f� <br /> S Reconstruction ❑ <br /> 0 e L Reconditioning ❑ L! E '• <br /> Horizontal Well ❑ <br /> f Destruction ❑ (Describe - <br /> I` destruction materials and pro- v <br /> �. cedures in Item 12) <br /> I 4 (4) PROPOSED US <br /> Domestic <br /> LYigation -. <br /> Ir duatrIal i ❑ _ 3' <br /> Teat Well ❑ <br /> Munici ❑ _ _ <br /> WELL LOCATION SKETCH b ) <br /> (S) EQUIPMENT: CRAv CK: <br /> amary ❑ Reverse ❑ No SI <br /> 1 ? <br /> Gblo Air ❑ et d bore <91SIZ <br /> k ! <br /> �.nher ❑ Buck ed rout - �Av cmil <br /> t <br /> (7) CASINCs INSTA EI1. (8) PE TI _ 'r <br /> Steel ' r* Ty d 'on or size d y _ <br /> From D G :or t - <br /> ft f Wnll I I. size 4A CZWV,, <br /> - <br /> - Z d vi <br /> (9) WELL SEAL: v�tG / — <br /> Was wuface anitary seal ptrn4fed? Yes IS No❑ If yes,to deptb ft. LIVWI - /! <br /> were struts sealed i lnst pollution? Yes a No❑ Interval <br /> �CrifPU�a'�CO�y7kv� Ire�•.n �r+` F <br /> nsethoddxalin work startrJ 19 Com Set t9 <br /> (10) WATER LEVELS: WELL DR1L R'S STATEMENT: <br /> Depth d first water,if knows it <br /> O ft This usell dri ed under m jurtadict d this report L',irsse to the <br /> Standing Ltvol alter well•:ompwion best of oul ge belie <br /> (11) WELL TEST. Sig — <br /> Was w-11 tat made' In❑ No lD If yep by-horn? iW Il 1hJ �i <br /> Typa or n.. Pump.❑ Railer ❑ Airlift [INAME ' ��/�� <br /> Depth:o way Y at clan d tit it. At end of test fl I i or noel 1-1 prult d) <br /> Discharse gal/min Aft" houn Watertemera <br /> pture Address �"��IE"� 16 <br /> n <br /> OKmical arialysis eude? Yes ❑ No* If yes,by whom? Citv _r ZIP <br /> Was electric icq nude Yrs ❑ No# If Yea'+trach c'r'py to this report License I`lo (s1_L,IrY1 Date of thin reptrt <br /> OWst 1N ilrCV. /A-SNI IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVZLY NUMBERED FORM <br /> CY <br /> i ! <br />