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ORIGINAL WATER WELL DRILLERS REPORT lG1CAT60NOj(JTjiWECv.0 <br /> File Original,Duplicate and Triplicate with the (Sect.ons 7076,7077,707C Water code) N? 34134 <br /> REGIONAL WATER POLLUTION State Well No— -- -- -- — r <br /> OONTROL BOARD No STATE OF CALIFORNIA - _ <br /> Other Well No <br /> 'ddomors/ppropru?r numb") <br /> � O R. / �}� (11) WELL LOG- <br /> NamZae •,(/ / �_� Teal depth St Depth of completed well it <br /> Address r Formar.on Drrn,br by rolor,rbn/rtn,spu of araJerid,/wd t7rssrHer► <br /> d it to it <br /> (2) LOCA)"ION OF WELL: <br /> t number,if goy— _ <br /> D or5trert No <br /> r D <br /> (3) TYPE OF WORK (check): <br /> New well 93� Deepening ❑ Reconditioning ❑ Abandon ❑ <br /> If abandonment,derersbe material and procedure in Item I I <br /> (4) PROPOSED USE (check.)• (5) EQUIPMENT• <br /> Domesm [�r Industrial ❑ Mumclpal ❑ Rotary <br /> Irrlgatlon [3Test Well [IOther 11Cable E3 <br /> Du Well ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE DOUBLE,1 Gage <br /> /� ,r Diameter r from. to <br /> From ft-to L 2 f , f tam /-..Wal► of Bore <br /> t J <br /> Type end sore of shoe or well ring Sae of gravel- _ <br /> Dacr.be lassie _ -- <br /> (7) PERFORATyON5 � <br /> Type of perforato-used <br /> Size of perforations �• ` len th b m 4 <br /> From / <br /> ft [n :���owi�f[ 1 erf per rax Rowa per it <br /> (8) CONSTRUCTION. <br /> Wu a surface sanitary ran?provided? vier"ea 0 No To what depth it <br /> Were any Strata sealed against pollutms.? 194. 0 No If yea,pore depth of strata <br /> From it in 71 <br /> ft <br /> Method of Sealing Work start 19 Complete 19 <br /> .�. <br /> (9) WATER LEVELS: WELL D LER'S STATEMENT <br /> This well was drilled under my jurisdiction and thrs report is true to for best of <br /> Depth at which water wu fint found or,, my knowfedgr and brlsef , <br /> ft NAME <br /> � <br /> drat le.el before yvfonisog _ W <br /> spR level alter perforating It (1,r firm curpcnt.on) (T7prd or pruned) <br /> Address <br /> (10) WELL TESTS: l <br /> Was a pump rept made? ❑ Yep 444" If yes by whom <br /> - <br /> Yield --------RZI/=a with it draw down afoaa.ssearessirs go bra / W/t <br /> Temperetvrc of water Wu a c tui anslynt made? ❑ Yea [0000 Licenfe N� .„_ _ Dated__ <br /> Wu electric log made of well? 0Yet o <br /> 911111111 7 sa aoM QUIN QQ PPO DW RM NO 246 (RaV a 54) <br />