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A t LOCATION AV 1 Vv`r-uV\L.V <br /> ORMINAL WATER WELL DRILLERS REPbRrx` Da Not F>'!1 In <br /> r l!le Orlglnal,Deplcaie and Triplicate will the (section,7076,7077,707s,water code) ;. � 1 9 9 5 <br /> REGIONAL WATER POLLTJ�ZpN L <br /> J� SUteVeitNo-- <br /> STATE OF CALIFORNIA _ <br /> CONTROL BOARD Nn, � <br /> (Interl approiarle nambrr) Other Well No. <br /> 1) OWNE 11) WELL LOG: <br /> Name f rI Total depIt !20 it <br /> Depth of eotnplated Wali I. <br /> Addre98 ? f Formatl*ax fhrrribe by calor,ehar►cler,Ilse o/"eforl►;and rlrerlare <br /> If7 it to It <br /> (2) LOCATION OF WELL: <br /> Ca a Owner's member,If an -r f a <br /> R.8 D or 6 et No • u <br /> e94 <br /> j I <br /> (3) TYPE OF WORK (Aec&): <br /> Newwell 5 Deepening © Reean&twning © Abandon El <br /> If abandonment,describe material and procedure in Iters II " <br /> , <br /> (4) PROPOSED USE (c,beck): (5) EQUIPMENT- ' <br /> Domestic M--fridustnal ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Othex ❑ Cable ❑ " <br /> Dug Well <br /> (6) CASING INSTALLED: Tf gravel packed , <br /> SINGLE <br /> /EJ-'13aust,Z❑ Gas$ , <br /> W.fr teR� It'1tam L �elE niameta �/frnm to , <br /> From nE Y1are Q!/ .[t.Q <br /> Type and au e[rhos or well rias Sbee of sravelt <br /> Darcriba joint , <br /> ,r <br /> (7) PERFORATIONS- <br /> Type <br /> ERFORA NS:Type of perforator rated <br /> Slee of pajorIllon, �7 m lenjith,by =A1la. <br /> From'26 ft t ft Peri prr tow � �Rowe few +. <br /> . .. . .. . .. iiia <br /> (jl) CONSTRUCTION: <br /> Wu a wrf■w nalnr�stat prartdtd? Vf. ❑No T.erlwx depth ft. „ <br /> Were anT stcat4 sealed aaaletx pollntioa? a ONO If ya,orate depth of strata <br /> Froze 5�t,3 rt 7 fr <br /> Method of Sealulg y wosk,tuted ,ea,r� 19 Coatpleced �,ff <br /> (9) WATER LEVELS- WELL DRMLER'S STATEMENT( <br /> Thts well war drilled under my furisdictlarr and tbls re�6ort ss true to the best of <br /> p _ °d d45r my knowledge and belief <br /> ME. <br /> level after perjo atoos -- - - - - - y � <br /> Be at which water wss fiat os r� <br /> lair <br /> Staadta level before a:[*tats° .. .._. �--slJ it, NAME �l�Cr9�'� <br /> it 7� R fixm,�corporation) 7 J / (Typed or prlaled) <br /> Address <br /> 10) WELL 'PESTS: r <br /> Was a pump tett made? 0 Yet ERIK If 7U.by wbem? <br /> Yitldt r� sal/moa with .�� it draw dawn after h,e. �,J(—.� Will Dr Nor <br /> em ��� <br /> 7emptratnn of water �'� was a ehlcai malrsit M26? Q Ya Lir.fin License NO „k,,,J GIy _ I�'a[!ej ,I _ <br /> boa- <br /> Vis slretr.c Ieg}nada of Veil? ❑Yet [!ma *saes a SA Bost GV IN Q epe <br /> DWR FORM No 246 (nzV 9.34I <br />