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ORIGINAL e WATER WELL DRILLERS REPORT Do Not Fill In <br /> ++ file Original,Duplicate and Triplicate with the (Sect ons 7075,7077,rorS,Water Cede) Nu 55310 <br /> REGIONAL WATER POLLUTION <br /> CONTROL BOARD No. <br /> STATE OF CALIFORNIA <br /> SauWdlNo.___-IN��'�}�...____..__. <br /> -ell ppropridle number) / Other Well No---------- ------- <br /> (I) O WNER: (11) WELL LOG: <br /> Name fL 1lLliysl _L eL�I -_ — ;� Tool d,rpth f:. Deprh of completed well 1-4 f <br /> ✓Vr Address /O J~� Form;tion: Describe by olo,,b--M,,size o1 mstn;dl,Ind slrscrlurr• <br /> ILL (2) LOCATION OF NVFF L: <br /> County Owner',number, <br /> R.F.D.or Steer[N.. <br /> r.. (3) TYPE OF WORK (c17eclt) <br /> \eve well R Deepening ❑ Reconditioning i] Abandon {] <br /> 1 f abandonment,describe rnaterial and procrdure in Item 11. " <br /> (4) PROPOSED USE (check); (5) EQUIPMENT: " <br /> Domestic F Industrial ❑ Municipal ❑ Rotary J131 <br /> Irrigation ❑ Other ❑ Cable ❑ <br /> i., Dug Well [] <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE❑ DOUBLE <br /> G.0 From f[ IO or of Ro cr ft. <br /> C ft. ro ��r.1 . (� Diem. kali ., .. <br /> l',-pe and,.. of shoe or+yell nng l a��,�, Sar of gra•e1- <br /> +"� Durril,e{oto[ / •• <br /> (7) PERFORATIONS: <br /> 1.0 Typr of prrfontar used - <br /> SiZe of prcdoras;ons in.,length,bT „ <br /> From fc-r f[. (j d Pctf.per row R.—per ft. <br /> (8) CONSTRUCTION: = "' <br /> 77' <br /> Wr,a surface sanitary sea]pro.ided? ❑ Ye: Q No To.ha[depth h. <br /> CPere.ny trat.scaled ag.i net poilo[ion? ❑ Ycs [I No If ycs,nate depth of rr.ti <br /> From ft.to Et. <br /> Method of Sealing Wort[started Jl—+{r7 19196 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> / This well was drilled ender my jurisdiction and This report is /rive to the best of <br /> Depth.r r h;rh.a a fir.t fownd J e fT• my knowledge o d belief. 00 <br /> -.n.•.d tax J-1 before pectora Ging fs. <br /> r pg le.rl after perfaneinx NAME 1 <br /> ft <br /> ( .r,o ,nem,or eur pets io t 7- rd oa-�.rnrFd) <br /> Address ✓ <br /> (10) WELL TESTS: ' <br /> IL. <br /> Wal a pump[em made? ❑ Ye. 7) No If yes,by vhom? <br /> Yield: Inv dove after T <br /> ESIGNEDI._—.-_-__._-...__-----------------/'/jl/' ._.__ / d _ --- <br /> —---- <br /> ..... <br /> xal./min. x;ch fa her. tiIIrfl Driflrr ' <br /> Trropenturr of vstcr Ws a chemiui.n.Irtia made? ❑ Yn ❑ No License No---- Dated_-_-_----................... 19 <br /> 'r-,e4c<:ie Joe m.dr of rel,? ❑ Ya [] No <br />