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- w,r►, iv,1 i$v ET 7H� <br /> V KW <br /> ead YrIP110te wdA'he <br /> CA,t.I FGA N 1 A <br /> Do Not Fill In <br /> WATER WELL DRILLERS REPORT" State Veil No, <br /> (Sections 7076,7077,7078,Water Code) Other Well o <br /> Region.__—»__ _--- - - <br /> orations - -of perforator used__2211f6440 - — - - -- - -- .�—_ _ —_ _ -- - -- - f — --- <br /> ype0-it to ---- fx Hole size_.____ -�-- -----No <br /> of holes____ - -------------- <br /> - - - <br /> Orated ._._ n ra 2121 ------------- - <br /> 2121 as n ----^ <br /> ' ---_ -------- 2121 n a <br /> ----' <br /> s ft <br /> ----- <br /> ----�—_ _ ---- _____ <br /> AmbF .— —__ — <br /> ----.--------_-_ <br /> —_— <br /> lomw <br /> rr ar -- <br /> IV <br /> -'-- — <br /> r, _____.____... ___ »-»_ 2121 <br /> _____»_ _______ 2121 ar <br /> _____—_ ______. 2121 <br /> - ra 2121 _ ____»__ <br /> - 2121 n <br /> ra -------- —__. ______ <br /> as 2121 ra <br /> 2121 fa __---------____ _ <br /> (�} Water levels. (9) Well pumping test. <br /> Depth at which water Date of test---_-----_----- Y whom-------- -"-- ---------- --- --ft <br /> first encountered__________________ _________---33-f t Depth to water when test started _-- <br /> G P M at beginning of test- __ ------_------ - <br /> -- -- - ---- --- <br /> Depth to water ft <br /> before perforating - __ __ __ft Drawdown from standing leve]__ _________-- .-. -- --- -- <br /> pe g - ft <br /> GPM at completion of test-__ <br /> Depth to water _AE <br /> perforating__ _ -___ ft <br /> Drawdown at completion of test________ _____ ______ _ <br /> th of time tes <br /> Len ted___ - ------ ----- --- <br /> Note any change in water level while drilling g _ <br /> ----- ------- <br /> _ Temperature of water ______ ------ -- - --- ------ <br /> Ap <br /> -- ------- ---- ---- <br /> ---- ---- <br /> Was gas present in watery F1 Yes o _ <br /> (10) General <br /> Was well gravel packed__ <br /> Size of rock ___ -- Thickness of pack <br /> Was a surface sanitary seal provided <br /> ---------------- ---- -Were any strata sealed against pollution) ❑ Yes ❑ No If yes, attach detailed description <br /> Strata sealed------- --- --------------- ---- - -- -- <br /> Was analysis made of water? ❑ Yes ❑ No If yes, attach copy E 1 t <br /> Yes No If yes,attach copy LZ DWas electric log made of well ❑ ❑If well abandoned, was it plugged and sealed'_____Method of plugging and sealing_- _____-__-- --------- <br /> )j���o.,.� (12) Time of work-(11) Location: .-r-�,a.�.. ` L"'""� r _____ ____ _ _ _ <br /> -12-51- Completed date_l2-27-51 <br /> Nortb Section No Work started date- - <br /> ------------ - Date of this report----`1-:0- <br /> - -- -- - - - ------ <br /> -52 <br /> Township------------ <br /> Range----- - ----- --- ---------- <br /> WELL DRILLER'S STATEMENT <br /> Base&Mendian- -- --------------- <br /> 1 was <br /> ed <br /> r 7my <br /> Show location of well in Sec- Thireport isstrtrel to the beslt of my knowlJedg Bthis <br /> and belief <br /> tion,thus (X) <br /> Distances to section lines from QR w0R1{S <br /> well, N or S ------------- <br /> -ft [SiGNsea] STS .T _ MOTOR'z'' Writ <br /> and E or W-_________--- f t (/c� r X_ <br /> Show location of nearest By <br /> known well, thus (0) License No fi2M50 Classification C-57 <br /> Distance to nearest known 19 <br /> 1 MILE Dared - - -- ' <br /> _ well-------------- f t - <br /> orr_rnwtat 'WATER POLLUTION CONTROL BOARD COPY <br />