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<br /> � }paeS , y Jai > u ��''3
<br /> ��,p.1-v.fir./r\
<br /> QUAOREIPUCATB i, {� r �L 1[11 .r' '? Jt�
<br /> 'ala la 4( „9r+ }.�"4'j y�rS° STATE Or CALIFORNIA JUtV 1 ht I w�DO tt0�{ 1 In if Z
<br /> Use to comply with r �' r� xYF"+ 11 79 s woo 1,
<br /> a ; THE RESOURCES AGENCY ( t a! w.
<br /> local I_qutrementsW.
<br /> ra; �9T395{„e 5
<br /> DEPARTMENT OF WATER RESOIES!)p,QJl� rIO r xy i w, 4y r
<br /> �,trtr,rf![tall�,,.�---f�My• NATER NVELL DRILLERS REPORT1_TH N3XVtieTYt*�r1t5�I k `"� °�'`" �
<br /> 1a w:n1 1'rnnt nr 1)ntr___ ;. .Other,\Yell Y ki`,� t Jv`na`��-a a1
<br /> (1) ON1•NER: Tpm FOrna SBTU 1 ) WELL Loc 1102 we Ill-Me Ra , f 7Q 4 „"
<br /> Name n
<br /> 7.
<br /> ( Tntil dept t.Depth o(i mpletetl wet
<br /> Add Irmo ft. to ft. Fnmmtian (Describe byadnr ch•trncter ant nr mnterinl)-r-Tf�1
<br /> Cuo I—} O s0
<br /> (") L�C'ATIQN OF—WELL (Sec metntrtions): - Send $�
<br /> 'C nt gn 0agTAP _O,vner's Well Number-_
<br /> .:\Well nddrrss if d,frerbnt hdrn nhnoc - r$. .}; rrP_! {y ' •
<br /> 4+7 k;jay
<br /> .'1' nshii+r 'Ilnnr.e - t., 7 Scctlnn
<br /> Ixtn,en fn m ci les,vends,lull r;;nd lentos,etc. n� �•1�_nne Rd_* 47
<br /> - •y F st 1'*¢H�rua•t"',6� z5,r�#�i Y.n rR\'. rf
<br /> 'mile west of.'.Chrisman Rd. north side
<br /> _ ..
<br /> - 0 C
<br /> (3) TYPE OF WORK: } �
<br /> y 0 94 •Grave �w, i � . � �� � �,,,
<br /> t' Xc.v
<br /> Well 111ening ❑ 1 05 Clwr
<br /> ! �, ,� r. ';r + t' �ti_t i` \ r( ]iY •ntrnctn,t, ..❑ 10 _ ':.G r *4T ti
<br /> Ct•.,A 1•. Y Ier t a,-.: !i onditionint! ❑ ,xr )C •vr-. t.q
<br /> II nixnntA Well ❑ v8 t 1zYr ,y�'lxt
<br /> • less, li p t 5 far t .. jw De,tn,cW,n ❑ (D<•.serihr .;,r$ ° -s p.t✓r f n:a if-?',
<br /> deo—tion
<br /> pe—dw- in Item
<br /> (4) PROPOSED U _ g,y J 'x ;e ,7 r. F ei 7'r}
<br /> S'! C ii .ti yr t t
<br /> Iinrrientn,ni,l;�
<br /> a.sit• x EaaZrll ` "f 1st dustr. ❑ �✓ ',. .c• ea?,
<br /> \
<br /> Tt+t Well \,� .❑ \ \\\i - %.. out a.: - id,!
<br /> W) _ c �`!-rlt",t^•, b.t L} -.,1•i"��y 'Y•�
<br /> kte,nia•itixJ �, t�\•`' ..�_�,\v' �:•J � �"'r�.:ac+:bc si<r•4+X.a.�'r.�;t?��Atir�}:
<br /> . .. \VELL LOCATION
<br /> SKETCH �/` Other ❑
<br /> i
<br /> ' (l) CTA(5EQUIP\FNT: \ � ��. i7vt y \ }rx t
<br /> • Y . S
<br /> .,.Il t n• licvrrtc ❑ ,\� N�:'. Sipe• /\�•�\/> a s Pir1,c ,r, ✓..,ria 7t•!j �}
<br /> C•,hle ❑ Ale
<br /> ..tar of it re
<br /> IC
<br /> ❑ 41v M� r1`�\ \`. _ sod'•je'�}... t..;�' ,d.ti�'\ x,7,
<br /> Other k,1 ❑' �pl>!u .{rmn-4`�• -hi_� :_fe.. \�, - f ..:�,. ,l y ,.k,4r3, ('6' :
<br /> :( ) C\SING INSTALLbU•rr <+•"'r't1V rf
<br /> 'tiled❑ I'Instic Ci,� l 71ix•of per{(\ n i\Aly of scree[✓ _ - _ [ r'r.t.� ytl�r'' �.
<br /> I rom T(l'.- Di t. 61. F,111 lo $10t\ J a
<br /> ft.. f )in,: Wall f \�5'zd
<br /> 1 bo
<br /> 12---' 1 CTee I
<br /> '(0) 1VELL SF,11,: \�y ?
<br /> N,i,fa- ow) l,pr idrd.' Yes (�. N, ❑ It > to drpth_50_.R.
<br /> \lora111.,til r 1.1 nt.+,'mt IN,Ilrtyum' Y'rs ❑ Nl. ,_ Inta•n.i l.__.___IL
<br /> f r,l t V__gf!e�1� 19 .('nn,plat 1 If)
<br /> (10)-RATER LI \•ELS: 1bT:LL D}tILI,ERS STATE\1E\T
<br /> Depth of fire[ , •11 dilled . -Wftin1rd whir rep N,h.,frt ce lu°,tRi l+erhrrJ
<br /> + 5„ l L 1 rel allvr cell a plrtirn,
<br /> 11) WN I 1 TLSTti ----- Str.Nr:n /% // (L i;<.. �/.rf�� l f ♦.
<br /> 11, ell tcel aule? Yes .Nviz` It ., 1),
<br /> -
<br /> T ? d feet i,p ❑ Iinticr❑ :\ir lift❑ \AME eT1�.T1Qo_ �Drl l l 41r1Q-^ •(�'_ Twp •� I
<br /> - tl'enon. fimt or a �--
<br /> i `DryNh t w,t r ,t tan 11 tcsl �.I t. :N end u( te.t__—fl rr*mth•n) f7}pal 1 rimed)
<br /> n nnflrr_ hou ra \i ntrr te,niw n,hrrc— \ddr s. _
<br /> Cl urel nnH „ lc .Yc '., N•, 3 If )r}, by whom?.__ C h
<br /> - _�-
<br /> N,,s r,,tri, 1,v.w ode? Yes rJ No If rr ::Ita•-h,opr h.thi. report Lice No.,-_ -W-11 - Dille of this rerv,rt
<br /> Is_:1:7
<br /> i
<br /> DwR let1,ORM 7-rel IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
<br /> I xrs /y.�]t ��F psi�r�lxt •"Lpt i j c'. f aF=�y�4 ..� �4 .
<br /> • Y ��� sl 1 Wl fp t I,h t Y M' .di � Y M � 7•. ,1' _ �,=-•
<br /> Yir Yr} •r„y��1T {,'S 7*' T 7 �•> _ + S.1•ti L, tl' ,,, et
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