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Of6GINAL RIe.Origina 1, Dl;plica it ^ Id Triplicate with the _ SHEET 2 v DIVISION OF WATER RESOURCES P. O. BOX 1 „ 79 SACRAMENTO 5 , CALIFORNIA WATER WELL DRILLERS REPORT Do Not Fitl In / Sta[eWeI1No.% !% - i-� ( Sections 7076, 7077, 7078, Water Code ) Other Well No- ------------------_--- j4:_� Region–___-- _____-__ ( 7 ) Perforations: =, - i<'2� T'ype �4 perforator used ._J Perforated -------------------------- ft. to------- -------------------------ft. Hole size-------------------------------No. of holes--------------------------------- -- ------------------- I' ------ ---- ------- --------- rIV „ 12 » » „ 11 k 32 -------------------------------- „ ------------------------ ------------------------ ---------------------------- » „ , » „ „ --- » „ „ - --- ---------- -- ---- ------------ ------- - --------------------- „ „ --------------------- -- -------- „ ---- ------- ------------ - - „ „ ------- ------------------- _- ----------- ------------------------ " --------------- - - -- ------- ---------------- --- - ----- -- „ » „ „ „ -------- --- ------------------------------ 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 I G.P.M. at completion of test----------r_- ----______------- -------------- ------------ after -_-- _ _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 : _ -! Was well gravel packed ?----- ----------- ----------------Size of rock---------- ---- __-_____-____-__Thickness of pack --------------------______-__--_ Wasa surface sanitary seal provided ? ----------------------------------------------------------- -------------------------------- ---- ------------°--- Were any strata sealed against pollution ? El 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 : Nortb 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 !` Diswell, N tances E oroV� ~o'_1i -- ft. QStcxEDl -----STQC DH-_1SHdIATIIBE _&�:OTQl; _WORKS — == � .. Show location of nearest -- ._ 1 known well, thus ( 0) 67850 e-57tE.r Distance to nearest known License No - ---- - Classifi acion___._---. -___— I MILE we]I-------- - —_ ------ft. Da ted_I!? . L.J D . W. R. FORK No. 246 REGIONAL WATER POLLUTION CONTROL BOARD COPY 23972 ,o,. _Via :en