Laserfiche WebLink
r ORIGINAL WATER WELL DRILLERS REPORT � Do Not rrll in <br />He Original Duplicate and Trlplicais with the (5—tions 7076 Tar 1� 7078 'War.r cone} 0 6714"1 <br />I <br />REGIONAL 'WATER POLLUTION State Well No _ <br />CONTROL BOAR,, NoSTATE OF CALIFORNIA <br />t. - <br />__ Z _ _ <br />1 / Other Well No � '""'e ^pprapnrtr rtarworr <br />Name <br />7'�oz"� <br />- - <br />Address 'WELL <br />(2) LO ATION OF ELL <br />iFtyr unonumD or Street <br />1 <br />(3) TYPE OF WORK (.beck.) <br />'Ne- 'well .9 Deepening © Recondtuonin6 ] Lb2ndon ❑ <br />ll abandonment drtcrsbr material and proeedurr in 11, 11 <br />(-f) PROPOSED USE (check) (5) EQUIPMENT <br />Domestic A Industrial j] Municipal 1 Rocary ❑ <br />Irrtgatlon [I Test Well �! Otner r --Cable 71 <br />Dug Well <br />(6) CASING INSTALLED If graN el packed <br />51NG�E�1 DOUBLE <br />F"� ur Dt=n+er f om to <br />From t to it Ot.m m,ll of Bore is it <br />Tvpr no .ace of .hoe or wei3 rm 5— of jr.vei <br />De.enb. twat <br />(i) PERFORATIONS <br />TTp. of Perforatrr aced � <br />StZ� of perfonnans is length by to <br />From fr it Pert per re. Row rr it <br />f� 11 e <br />' (8) CONSTRUCTION 1 <br />'Wu a t.rf... .... r-3, real prondedl IE Yes_ ❑ No. To what depth , / �J it <br />mere —Y scr.t. sealed agMa.t p011ar4pal ❑ Yes •❑ No If Ye+ nate depth of reran <br />From ft to it <br />Method of Sealul,g <br />1-17 <br />(9) WATER LEVELS. <br />Depth ar whueh water r" first found it <br />St—d`X level before perforao)ns ' it <br />Sun. le.el afser perforat.nit-r-3ft <br />I I a) WELL TEST <br />S <br />'Wst s putop ce.r made} ❑ Ne If les br whom7 <br />Yield xal /mus with !t or.. down after bre <br />Tempertcure of wiser ma.. cheun-1 anal•... m.d.t ❑ Yea ❑ No <br />' Wit tiertrtc loc made of ..11? ❑ Yee ❑ No <br />( I I) WELL LOG <br />Total dent}, /� ft Depth of completed sell 'a.L <br />rormauoo Dnrrrbr by rotor rber.ren .txt or unaera! end trrvrrurr <br />'Work .carted t;y� 19 Z7 Completed � t9 <br />WELL DRILLERS STATEMENT <br />This well was drilled unser ray lursrdietion and this report it true to the best of <br />my knowledge asd brlstf <br />NAME <br />� ir�rraon arm earpera ttu ! .. � x7 y1; ur p ted) <br />Addrai/'`1�r ////f�`•�%�F % E -'/ <br />✓ <br />Weil Drfffer <br />License No _ ____ _ Dated— <br />17015 6 37 foes 0utr+, aro 3 DWR 1S8 (REV 3 541 <br />