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LOCA <br /> TION NOT CHM <br /> f 'ORIGINAL WATER. WELL DRILLERS REPOR,e„ Do IYot Fill In <br /> Ft1e Original,gapllcals and Triplicate with the r � 0 <br /> (9eetiaAf 7074e 7077,7078,Wasas Code) <br /> REGIONAL WATER POLLUTION N <br /> corTrxoz. IiaARn How z____ STATE Off' CALIFORNIA Scale Well No----- <br /> (lnrrrt aypra/r!e)r paatbrr) Other Well No. +�'ya• «*'...c~rW <br /> R: <br /> (11) WELL LOG: <br /> Name Cyt �� `� Total daptk <br /> ' f/ <br /> d�it IIeptit of coin sated well <br /> Address `. a Aortattians Derer)br by eolor,dwrader,..i.r1w�a..f�-,mein)1,emf rlrarley <br /> Ee co <br /> Qr a <br /> (2) OCAON OF WELL: V <br /> s <br /> Co aeTta number,if say-- -• Q <br /> R !11D ar Sir o • > ✓;� �� <br /> f <br /> s <br /> �4 <br /> (3) TYPE OF WORK (cbecA) <br /> New well Deapetnng [) Reconditioning ❑ Abandon ❑ 7 3 l , <br /> If abandonment,drserrba matnlal acrd p^`atrdure 1n Ittm 11. • E �y <br /> (4) PROPOSED USE (check): (S) EQUIPMENTS <br /> Domestic [] Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Teat Well ❑ Other m. Cable ❑ " <br /> Dug Well <br /> (6) CASING INSTALLED: If gravel packed <br /> slNal_E aaual_IZ© fin <br /> � j <br /> ore Diameter from l to Obi 7p ` T <br /> From ft.to! ft Diem Wail of Ban ft �/S{,I fe <br /> Type tad site of shoe or well raps &ze of gratatj„ ' <br /> Desufbe joint e- <br /> (7) PERFORATIONS: <br /> Typo of petfoaearrsed r �� <br /> Size of rfarat(ene en 1fnRth 6 (q <br /> From (t en t� )t Aa per) pwrrow Rowa per Et <br /> u • <br /> (8) CONS'T'RUCTION:����++ <br /> Vat■awfun eeoitasy teal provided? [yYa 0 No To what depth Et 1 <br /> Were any atrats sealed aIgmt pollution? Q''yts ❑Igo If yet,note depth of nut; <br /> Froin �t— ft sa4LIEr <br /> Method of earmssauced <br /> 1 s , Compiared E7 f <br /> (9) WATER LEVELS: WELL DRILLER'S STA'T'EMENT <br /> Deptb at Which Crater wa ff»t foond 'I y 7hla well was drilled ander my lurtadirlion and this report is trot to the beat of <br /> t my Anowlydst and b11101 <br /> Standlag laves before <br /> rs perforating ' <br /> *AME lid',d 114 late]after peEont[aR �' Igl J e J <br /> " <br /> (pMtaa,Sf e7oe cotporactonl fY'yped or <br /> ' ddress <br /> (10) WELL TESTS: f 4�• I� <br /> ,,.Ylro.� s <br /> was a pomp te,t made? E3 Y" LIf pue by wiwm? <br /> e <br /> Yeelde "Aa1 ft draw dawn after <br /> y <br /> Temptrature of water „��' Was a eteean,ol aaalyals made? (3 Yea a l r..� wrtf Driftsr <br /> CYl� License No6l,.�J?•/ [ Diced _�J '19J/ <br /> �1]tiectrle lag*rade of wen? Q Yq al His aaesa i ae aoH QUIN 0 spa <br /> 4WI? KOgt.1 NO 240 IktgV 9 81l <br />