Laserfiche WebLink
IL ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> �T <br /> File Original, Duplicate and Triplicate with the (section. 7076, 7077, 7078, Water cede) lr O 56570 <br /> REGIONAL WATER POLLUTION State Well No. _.r.. _ __ f <br /> STATE OF CALIFORNIA 23J <br /> CONTROL BOARD No. / Ocher Well No. lId�6E <br /> `. 1 (Insert appropriate number) /L `� `�-' - - . <br /> I : ) OWNER: ( 11 ) WELL LOG : <br /> Name •�„ ._✓ N Lf _ Tal depth /Jrrprb of completed well sr. <br /> 1 Address Formation: Describe by color, rhalrarver, stir 1 motorist, and trPOure . <br /> ( 2 ) LOCATION OF WELL " re) <br /> Court ` " 1stl4i Danes s number, if e / 7 <br /> R. 'I verlel <br /> F D. or Srrte{ No S .� f 7'I7 /: n __ L ._ ':Lwl ., � J` <br /> of G / 44over, Gq <br /> /• /. 7y iJ— 4f <br /> ( 3 ) TYPE OF WORK ( check) : <br /> � . .. .I New well G't Deepening ❑ Reconditioning C Abandon ❑ <br /> Ifirbandristrusel daniba material and procedure in lien 77. Fri <br /> . <br /> ( 4 ) PROPOSED USE ( check) : ( 5 ) EQUIPMENT : / `lam ly, S L -• yC <br /> t-i411 <br /> , 7 <br /> Domestic {] Industrial El Municipal ❑ tart <br /> Roj le /� — � — <br /> Irtiganon E] Test Well [_1 Ocher ❑ Cable ❑ i <br /> Dug Well ❑ <br /> ( 6 ) CASING INSTALLED : 1l gravel packed — <br /> SINGLE 21 DOUBLE _ Gage , -- - ----- — <br /> Diameter from to _ <br /> From Cr rims. 7 . 7 it, � Y Diarrid vcan of Bore It. is, <br /> r --I <br /> 1 <br /> I — <br /> Type and size of ,hoe or wdl tins % ' Site of g,Fair .. --...-- -- <br /> Det vibe ) �� •' <br /> ( 7 ) PERFORATIONS : . — <br /> Type at perforator used .. . . <br /> $Ile of Perforators <br /> ,n., length, by ba, .. .. <br /> �I From ft. in ft. Prof. per row Rr_..., per ft. .. .. <br /> I . . . . .. .. . . .. .. .. <br /> ( 8 ) CONSTRUCTION: IF <br /> Was a surface sinister seal provided? ❑ Yet ❑ No To what depth £t. <br /> — ' Were any strata sealed against pollution? .Z Yea ❑ No If yes, note depth of strata .. <br /> From ft, to it. <br /> 1 Method of Sealing a _ Work started tad 17 <br /> WELL DRILLER'S STATEMENT: <br /> ( 9 ) WATER LEVELS : This well mm drilled ander my jurisdiction and this report is true to the best of <br /> JDepth at which waterwas first found it. my knowledglIfl and belief, 1 <br /> Standing level before perfon:int ft. IF - 1IA.i✓.. /ri%� ' % / 11 -/( V� /` 7/ f• <br /> ng level after perforating it . i. Fritz . i / ` /. <br /> i Address • �;1 ✓ x/- <br /> ( 10 ) WELL TESTS : <br /> j Was a Pump test made? ❑ Yes ❑ No If yes, by whom ? `J } <br /> . . [SIGNED] / _ <br /> � ,. Yield : ' sal./min. with [t. dr.w down after brio ._._.___.._..-_...-. -- , e.eL�__ 2L:'�-------- -------------__---— <br /> ,,IliVrll Driller <br /> r Temperature of water War a chemical analysts nide? ❑ Yes N❑ <br /> < .� o License No. --- . --- ..-._..._-__.__.__..-. Dated----------- _._.Foos 19._.. _ <br /> Was electric log made of well ? 0 Yes 0 No - <br />