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- ' d O F2IGINAL RIe.Giigina I, D-;plicaie:'IdTriplicate with the _ SHEET v DIVISION OF WATER RESOURCES P. O. BOX 1u79 SACRAMENTO 5, CALIFORNIA WATER WELL DRILLERS REPORT Do Not Fitl In (Sections 7076, 7077,7078,Water Code) Other Well No.>__-._-____ --------------- Region----------------------- (7) Perforations: =,- i<'2� Type�of perforator used------------------------------------------------------------------------- ------------------------------------- ---------- -------------------------------- Perforated----------------------------------- to-------------------------f t. Hole size-------------------------------No. of holes--------------------------------- a ,."J -- r ----- --- ---- - --- ---- » » „ „ » „ ------------------ -- -------------------- „ ------------------------ ------------------ - -- -- - „ „ » „ „ » „ ---- ---- -- - - -- -- - „ --- ------------------ ,> „-------------------------------------- » „ - ---------------------------- „ „ ------------- ---------------------- 11 _- ------------ ----------------------------- " ------------- ------------- --------------------------- „ » „ „ „ -------- --- ------------------------------- (8) Water levels: (9) Well pumping test: Depth at which water Date of rest------------------By whom------------------------------------------------------_ first encountered----------------------lg_.................ft. Depth to water when test started --------------------------_----------------------- ----ft, Depth to water G.P.M. at beginning of test_------------------------------------------------------ _____-_ !. before perforating-------------------------------------------ft. Drawdown from standing level------------------------------------------------------ft. Depth to water G.P.M. at completion of test----------r_- ----___________-_____-______-_-- _ _I after perforating_____------------- _ - ____________-__-ft. Drawdown at completion of test ------------.---ft. l I Note any change in water level while. drilling Length of time tested__,__—__-___-____-_-__-___-____-______-__--_-__-____--_ l --------------------------------------------------------- Temperature of water-------------------------------------------------------------------- Was gas present in water? ❑ Yes ❑ No (10) General: _ _I Was well gravel packed?-_--------------------------------Size of rock--._---______ ---- -------------------Thickness of pack ---------------------___--___--_ �i Was a surface sanitary seal provided?----------------------------------------------------------- -------------------------------- ---- ------------°--- Were any strata sealed against pollution? ❑ Yes ❑ No If yes, attach detailed description. Strata sealed- ----- -- —- -- --- -- --- - - - - -- - --- - - ---- -- - - --- - - r Was analysis made of water? ❑ Yes ❑ No If yes, attach copy. l-- Was electric log made of well? ❑ Yes ❑ No If yes, attach copy. If well abandoned, was it plugged and sealed?----- ---------------------------------__-__-__.___-__---__-_-_-__-_____-_ F Method of plugging and sealing----_-------------.-------------------- ---------`----------- ( 11) Location: (12) Time of work: Norte Section No------ ------------------------- Work started date---3-6-5LCompleted date--3-6->`1-- ! Township--`-------`- ----- Date of this report__5-1-5=51---------- ------------------- ------------ Range---------------------- j Base &Meridian_---__________-_ WELL DRILLER'S STATEMENT: Show location of well in Sec- This well was drilled under tny. jurisdiction and ibis tion, thus (X) report is true to the best of my knowledge and belief. nes from! Distances well, N o V S3/ -'-- f S ----- t. QSIGNEDI----- TQC DN---AMIL'TIIBE_&3:OTOR-.WORKS and E �.. _eft. ! ! Show location of nearest known well, thus (0) 67850 e-57tEr1 Distance to nearest known License N�o.-____-_..-- .- Clasvfi a tion___._--_-___- I MILE we]I--------- —_ ------ft. L.J D.W.R. FOR. No. 246 REGIONAL WATER POLLUTION CONTROL BOARD COPY zasrz isu.ow _ma :.o