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qu aoRUPLICATE r _ WATER WELL DRILLERS REPORT Do Not Fill In' ' <br /> RETAIN THIS COPY (sectinna 7076,7077,707B,water code) N. <br /> 115 913 <br /> Scare Well No. _ <br /> THE RESOURCES AGENCY OF CALIFORNIA Ocher Wel INo—____ _- <br /> OWNER:` n cagurrz6o« y t,,fri(-.V- <br /> O (X X) WELL LOG: <br /> Name � r Total depth r t tP ft. Depth of compketed well � <br /> Address �� s Formation;Drrcribe by color,rhardtirr,ximr of maderiai,nvd dr¢eirre. <br /> fel,to ft. / <br /> (z) LOCATION. OF WELL: <br /> Counry `�•,�� Owner's number,if any— <br /> R.F.D.'or Street No. <br /> CT <br /> I F: MJ f J •L <br /> (3) TYPE OF WORK (check).- „ <br /> New well Dee in Recondi[ionin � �� <br /> P� S © f5 ❑ Abandon ❑ <br /> Y1 .0 A <br /> If abandonment,describe material and fi7ocedure in Item 11. ASt <br /> a <br /> (4) PROPOSED USE (cbeck) (S) EQUIPMENT: 2XJ74i ; t <br /> Domestic ❑ Industrial [:] Municipal JL'!Y Rotary ❑ .� '' "" k v `` t <br /> Irrigation ❑ Test Well ❑ OtherCable ' _w " AtAs, <br /> Dag Well :Q <br /> P <br /> (6) CASING INSTALLED: If gravel:packed „ <br /> SINGLE} DOUBLE ❑ Gage <br /> g <br /> or Mmerer from to t' <br /> From ft.to ft. Via— Wall of pore ft. ft. <br /> AL <br /> Typraod size oF.eh«Orwell ring' Size of gavel: <br /> Describe joint - <br /> (7) PERFORATIONS: <br /> Type of perforator used <br /> Sizeof perfontions n.,length,by- - in.. <br /> From ft.to £t. 'Perf.per row Rows per ft. - <br /> . <br /> .21 <br /> J . <br /> (B) CONSTRUCTION:. <br /> Was a surfue saninry teal provided? +E) Yes ❑ No To whit.depth - fr. _ <br /> WLR any strap sealed against pollution? ❑ Yrr ❑ No If yea,mu depth of.attar,- . <br /> From ft.to ft. .. ., <br /> Method of Sealing x Aj ,m19 Work eed a_ 'Completed <br /> - s. <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> l.. This well was drilled under my jurisdiction and this report is truc to the best of <br /> Depth at which crater was first found �� � 'Low fr. my knowledge and brlirf. <br /> Stsndinp level before perforotins rt <br /> if _ _ NAME <br /> Ierel after per ft. (Person,firm,or corporation) <br /> _ (Typed or pi.W) - <br /> ._ Address <br /> (10) WELL TESTS: <br /> Wsr a pump test made? I] Yes ❑ No if yrs,by whorn? ' <br /> Yield: - gal./min. with ft, draw down after hra. - Wdl Driller <br /> Temperature of water Was a chemiear analyse made? _❑ Yes ❑ No License No.—.__ <br /> vl electric lot made of well? 71 Yes 1 1 Nn <br />