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ORIGINAL.. WATER WELL DRILLERS REPORT " v Do Tot fill In <br /> (Sections 7076,7077,7071,water code) <br /> �d <br /> I File Original,Duplicate and Triplicate with the # <br /> DIVISION OF WATER RESOURCES _ f _ � -State Well No <br /> _p o Box 1070 STATE OF CALIF'ORNIA—E)£PARTMENT OF PUBLIC WORKS <br /> 1 <br /> SACRAMENTO g � p,1C/A]IIFOgNIA <br /> DIVISION OF WATER RESOURCES Other Well No <br /> �' • / �'IV/`F �. Jo►JfS _?1t1q , f-��G A- 'J3 Region—_ ..... <br /> s 1) DRILLER: person, f1m,4r p6rporation) (B) LOC ION OF ELL, <br /> Name t / a County �.J <br />' Address J ,� A F or Street No <br />' OWNER• � r� 17/11- ILL ,� <br /> Name V t r (/+ Y �11 �'�i �i+ AUF <br /> ._trs <br /> Address 1 (9) WELL LOG <br /> Z _ f Total depth of well !� <br /> t <br /> Formsteon t Mention tae of water gravel— <br /> ft to ft <br /> 2} Proposed Use (Check) Equipment � JT �, <br /> 11, <br /> Domestic [ Industrial ❑ Rotary <br /> Irrigation ❑ Test Well Cable <br /> El <br /> Dug Well <br />' Municipal ❑ Other ❑ Other ❑ <br /> (3) CASING. 1 !� <br /> ft of to 49L ­WXI aging 10, left in well -7 <br /> i <br /> Type and aexe of shoe or well ring �� <br /> (4) PERFORATIONS <br /> ype of perforator used <br /> Ferforated it to it holes per in <br /> t 1 <br /> 1 ti. o <br /> ,r <br /> ]Diameter of prrfotatwns_ •�.en, length _ .....,..n ' <br />' (5) WATER LEVELS. <br /> Was electric log trade of well? ❑ Yes ❑ No If ytt ttaeh copy <br /> Depth■t which water was first found l^) it „ <br /> standing level before perforating it „ <br /> Standing level after perforating It <br /> Note your o6servation of any change in water level white drilh"g f 'I ) <br /> Was a epefacetanttary seal provided} <br /> 1 (6) WELL PUMPING TEST- Work started „ ` 1 ca>»pletad n!4-,ll r Ls+ <br /> Capacity gal/men It draw downf — .j <br /> I?ate of Report d 19 <br />' WELL DRILLER'S STATEMENT <br /> Was well gravel parked? This well was drilled rluder My furudictrou and this rrporf is true to the <br /> Were any[trait sealed against pollution? of my knowledse and belief �� <br /> f — _ -- <br /> i <br /> a emperatiire Attach a chemsal analysts made? copy 1$IGN�D3 /�/ __ii�t_ � /�/ _ <br />' I[abandoned was well capped? —-- —— — _ _-- Well Driller <br /> By _ <br /> (7) TYPE OF WORK (cbeck)' License No —Clasaafitanon_ <br /> Deepening existing well [] _ <br /> New well Reconditioning of well ❑ ---__—_r Is- <br /> 46370 ______ _r al a0M OU IN ID SPO <br />