Laserfiche WebLink
ORIGINAL NI%NW.TER WELL DRILLERS REPOI Do Not Fill In <br /> File Original,Duplicate and Triplicate with the (section,7076,7077,7078,Wrote,Code) N9 55310 <br /> REGIONAL. WATER POLLUTION State Well No.-_...1N/-6F,4 <br /> STATE OF CALIFORNIA ^ C <br /> CONT,30L BOARD No. ! C� Other Well No.____-__.---._._ <br /> 'ret appropriate wasmbrri ....----_._---"-'-. <br /> (1) OWNER: 0 1) WELL LOG: <br /> Name ��yyt/ Total depth ft. Depth of completed well �/ ft. <br /> .Address /D')-y � Nx �_� a-, Formation: De,—br by color,rbnacln,size of tnalnral,awd tlrwrlwrr. <br /> ft.to it. <br /> (2) LOCATION OF W L: <br /> Courcy Ownet'a number,if any— <br /> a49G e, <br /> 6— <br /> R.F.D.or Sverc No. <br /> z - <br /> b 7 <br /> 2z y� <br /> /0 <br /> (3) TYPE OF WORK (check): <br /> New well i9 Deepening ❑ Reeonditiuning ❑ Abandon ❑ " <br /> If abandonment,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: " <br /> Domestic [I Industrial E] Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE DOUBLE Gag,or .. -. <br /> Diam,ter from ,o <br /> From p ft rn //Q ft. Diam. Fall of Bore ft. <br /> Type and uz<of shoe or well nng / Sa<of gravel: .. ., <br /> Dmcribe joint <br /> (7) PERFORATIONS: <br /> Type of perforator used •• <br /> Sfze of p<rforadon, in.,length•by in. <br /> From / 6 r Perf per rou R,a.per ft. <br /> (8) CONSTRUCTION: v r <br /> Was a surface sanitary ted provided? ❑ Yea ❑ No To what depth ft. ,• <br /> Wee,any a,rata aided aS i.,t pollution? ❑ Yet ❑ No if yet,note depth of nnta .. .. <br /> From ft.to ft. <br /> Method of Sealing Work t,trted //-�,� v6p C<•mpl,ted <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> t This well was drilled under my jurisdiction and this report is true to the best of <br /> Depth a which water wv firs,found ft• my knowledge apd belief. <br /> S,—d1,1 d level before perforating ft' NAME <br /> level after perforating ft. 1 "soh' <br /> rao firm,m.ur pe rayon; �, id at-1•nwlt,l/ <br /> Address J - ! <br /> (10) WELL TESTS: <br /> Va.a pump—,mad,? ❑ Y.. ❑ No If yet,by whom? <br /> Yidd: gal./eais, with ft. draw down af,,, hr.. - - Call Driller <br /> Temperatur<of—t, Wn a chrmiul analyait made? ❑ Yea ❑ No License No..-- Dated <br /> Was electric lot mad,of well? ❑ Yea ❑ No 67026 ave+sow QUIN c7 aro DWR 188 (REV. 3.64) <br />