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pIGI�lAL, STATE OF CALIFORNIA <br /> Fle Origliid;bdplicale and Triplicatewith fhe - - SHEET 1 <br /> DEPARTMENT OF PUBLIC WORKS (' <br /> ;DlYISlDIi OF WATER RESOUREES <br /> BOX 1D78 DIVISION OF WATER RESOURCES <br /> - G/RAMENTO �'CALIFORNIA <br /> Do NotFz l In = <br /> ATER WELL DRILLS State Well N .� s 1: <br /> RS REPQRT: Other Well <br /> (Sections 7076,7077,7078,Water Co )de <br />'- Region ---------------------_ - <br /> (1) Driller- <br /> Name_-� _ - - (z) Proposed use or uses (check): (3) Equipment used'.;-�:•, <br /> - _----______ Domestic ❑. Municipal E] (check) <br /> Address__________ --__: � J U_ Irrigation Industrial ❑ Rotary <br /> - - ✓ <br /> Domestic and Test well ❑ Cable <br /> License I�To. —�,C_u _ Classification_— ._____ Irrigation ❑ Dug well ❑ <br /> Other--------------------------------------------- <br /> C_%__ <br /> Owner; , <br /> Name - 1� �1�1- ��/--{-�•-. -- ----------------- <br /> . (4) Type of work (check): <br /> Address-__ �i n �" <br /> �` -c �,�-----•-!S<-`i------------- --- New well Reconditioning of well ❑ <br />' --------------------------------------------------------------------------------------- Deepening existing well ❑ <br /> 1 <br /> 3 Well log: <br /> Weal depth of well-____�_�_..__ - <br /> Tot fE. Give details of formations penetrated,such as silt, peat, muck, sand, gravel, clay, shale, sand- <br /> stone,hardpan,rock. Include size of gravel (diameter) and sand (fine, medium, coarse), color - <br /> Depth From Ground Surface of material, structure {loose,packed, cemented, soft, hard, brittle). <br /> - - -ft. to--- <br /> I <br /> o -----------ft. <br /> -1 „ n <br /> I --------------- <br /> ----- G ; <br /> 1 „ <br /> ------------- <br /> ------------ <br /> (,_�- <br /> - ----------- <br /> Lj <br /> `---------------------------------------- , ---— <br /> „ „ - „ <br /> --------------- -- <br /> ,.----------------------- <br /> ,. <br /> „ <br /> „ „ --- <br /> ----------------- <br /> -----------. . ---------------- <br /> -------- }' <br /> ------------ <br /> ---------------------- > - ---------— <br /> TOR OF AL USE Offy <br /> ------------------ <br /> -- <br /> .. <br /> I£additional space is required, continue on DWR Form No. 246—Supplement, and attach to respective report copies. <br /> (6) Casing left in well: <br /> LENGTH' DIAMETER. SINGLE.DOUBLE,WELDED, - - "'1"'�. •" <br /> FT. - INCHES HER � LBS.PER FOOT OR SEATING BELOW. <br /> OT ' <br /> > . .. GE GROUND SURFACE. FT:.,- <br /> , <br /> M <br /> -�„ w; <br /> 77 <br /> Type and size of shoe or well ring Welded !Dints— Yes ❑ No1 <br /> P W R FOAM <br /> ti a -� r REGIONAL V7ATEl�POLLUX ION CONTROL BOARD COPX , _ "• <br /> 27471 3--50 IoM.7V iN <br />