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ORIGINAL Not Fill In <br /> WATER WELL DRILLERS REPORT DO gg <br /> .File Original,Duplicate and Triplicale with the t <br /> _ -_(Sections 7076,7077,707X,Watrz Gads) _ _ _lSt M (.r- <br /> Is <br /> � <br /> DIVISION OF WATER RESOUR[Ei - State Well No <br /> Is o eOX 1079 STATE OF CALIFORNIA--DEPARTMENT OF PUBLIC WORKS <br /> CRAMENTO 6 CALIFORNIA DIVISION OF WATER RESOURCES other well No <br /> Region---- <br /> I) <br /> egion---_1) DRILLER' (perso , firm, Corporation (8) LOCATIO OF WELL• <br /> Name i'~ ' e / County _ rr <br />' Address R FV or Street N <br /> 611A-/-j`7, L' Gl { N <br />' -S tl al�„1<.-a— <br /> OWNER• ..� r , Y>l�-'4� rC'c� [J <br /> Name <br /> I Address (9) WELL LOG <br /> Total depth of well <br /> eAAC--TTU31 43I - QST 1=- P-0, Formatio INearson ssze f water gravel— - <br /> (2) Proposed Use (Check) Equipment ft to ` it ^ <br />' Domestic Industrial ❑ Rotary ❑ v <br /> Cable <br /> Irrigation E] Test Well I--] Dug Well � �l <br />' Municipal ❑ Other ❑ Other ❑ <br /> { /1 <br /> (3) �A JING. <br /> �. ft of P7 In n /ga easing rleft-in well - �- ,f , <br /> 1 Ips <br /> ' 'Y r?•rr ,L�Typo and size of that or well ring <br /> •� (4) PERFORATIONS: jr—��C� <br /> i ype of perforator used ,may <br /> Perforated it to it hole` per <br /> w <br /> Dumetor of perforations 7 V- length In f Y <br /> (5) WATER LEVELS. - <br /> Was electric log made of well? El Yes No If yes attach copy ^ <br /> Depth it which water was first found _ _ it <br /> Standing level before perforatsng it <br /> I sundtits level Ot[r perforating fe P- <br /> Nate your observaiton of any change in weer level while dulling f1�r t,di <br /> W13 a surface sanitary teal provided? <br /> ' (6)' WELL PUMPING TEST Work started completed hk 1M+' <br /> Capacity gal/maw ft draw down Date of Repan 1 19�t <br /> I WELL DRILLER'S S'T'ATEMENT <br /> Misr well gravel packed? This well was drilled tinder my fnrisdsctiort and this report $s trnr is the bt <br /> `sere any strata sealed*gains pallouon? ,,y, i if k—f, i s1' � l�hL'a-^(.i o/nay kuo wledge stets belief <br /> Zr _r ,_ <br /> Attar /1• e � f <br /> {� I'emperar ure VWasa chemical analysis made? copy 1$IGNI~D _] _ ---�—— <br /> If abandoned war well capped? --Will Driller <br /> (7) TYPE OF WORK (cheek)• License No Classification—­­­ <br /> New <br /> lassification ....-.—.___--_.__New well Q. Reconditioning of well 0 <br /> Dated— —..- <br /> Deepening existing well ❑ cam 7 at i9m CuIN OO CFO I <br />