Laserfiche WebLink
ORIGINAL WATER WELL DRILLERS REPORT <br /> ! Do Not Fill Ix <br /> Re OrIgInal,Duplicafe and Triplicate with the (11"llons 7016,nary,7.078,Water code) NO 56 70 <br /> REGIONAL WATER POLLUTION State Well N.—Z �= Z <br /> CONTROL BOARD No STATE OF CALIFORNIA�4� <br /> .!Icor!appreprfste lrgtaberl Oilier Well Na <br /> .) OWNER. (11) WELL <br /> 44 LOG. <br /> Name N <br /> Total depth Q it Depth of completed well it <br /> Address 47 Deicrsbr b)toter, 6rsrin,arse of maearmf,and a,acicrr <br /> ft w <br /> it <br /> {2) LOCATION OF WELL j <br /> County \ <br /> Owasr s aunabee of nay— <br /> R F D or Str No S <br /> I w/f <br /> t <br /> (3) TYPE OF WORK (check): <br /> New wr11 Deepea ms ❑ Reconditioning ❑ Abamdoo ❑ JYJ jy/ <br /> I f abaredoramext,describe msterssl end proeedure M Item 11, .� <br /> (4) PROPOSED USE (check). (5) EQUIPMENT. 92. <br /> Domestic ® Industrial ❑ MunlclP21 ❑ Rotary ® <br /> Irngation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED, If gravel packed <br /> SINGLE® DOUBLE i Gage <br /> nr Diameter f am to <br /> From D it to it Dssm Will of Bore It it <br /> T pe sad size of shot or well nag Size of grayel <br /> Daer.be io.n[ <br /> (7) PERFORATIONS: <br /> Type of perforator used <br /> Sue of perforatwas in length,by ao <br /> From fr rn ft Perf per row Row,per is <br /> (B) CONSTRUCTION: <br /> War a Surfs"sanitary zeal pruvsdedl ❑ Yea ❑ No To what depth <br /> Were say strata scaled atsaast pollution? Yes 0 No If ya nom depth of ecraca <br /> From it ra it <br /> Method of Seahng7Por4 starred (.� 19 / t omDle[ed /� 19 g,T <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> Thu well war drilled render my invisdlctton and this report is twee to the best of <br /> Dt9th at which water was first fotand it my Iter l d [and belml <br /> Standing level before perforating it 1? <br /> _ a <br /> `mg!nal afesa paforanng it !l'erwa rm or eorosrat.oa. or rna r <br /> t Address % //, <br /> (10) WELL TESTS: <br /> Val a PUMP Me made? Q Yee ❑ No If TO by wheal? <br /> Y.sld gal/mea w.th it draw dowa after bis tirfbfNer <br /> Tetapereture of water Vat a eham.oI analysts mads? 0 Yer 0 No license Na <br />