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OR161NA!' WATER WELL DRILLERS REPORT Do Nat Pill 1W <br /> File Original,Duplicate and Triplicate with the (Scaians 7076,1077,7016,water Code) <br /> REGIONAL WATER POLLU ON WK • F( � 4291 <br /> Ido - -• <br /> CONTROI, tare Well BOARD Iva ..� STATE OF CALIFORNIACALIFQRNIA <br /> (lnrtre approprreer number) _ Other'Wdl No. - ----- <br /> �) O R- (11) WELL LOG- <br /> Name U� l Total depth ++�� <br /> •.�. it Depth of enmplexed well fe. <br /> Address ` <br /> f �Ae <br /> Formateoet Ilescr)br 67 color,tbatrceer,size Of matertal and aerucenre <br /> i <br /> of fr to fc P <br /> t.E <br /> (2) CATION OF WELL: �,�0•�FC7e3r+� ..may syr e r <br /> Coma a.. n i numInw'if any— <br /> R. ' R LIJ r <br /> j 1 -� rt J iY <br /> R.Y D Se1 <br /> ej <br /> "i,�t r r ����� �' � q- � g2 <br /> (3) TYPE OF WORK (check): d r� <br /> New well Iy Deepening Q Reeondlsaontng ❑ Abandon [3 " <br /> If abandonment,descrihr material Bird Procedure to Item I1 _ <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic gybdustrlal ❑ Mumclpal ❑ Rotary [ <br /> Irrigation ❑ Test Well ❑ Other [] Cable ❑ <br /> Du Well <br /> (6) CASING INSTALLED: If gravelpacke4 <br /> SINOLE Uj -trQUUL~C) (rage <br /> Diameter from to <br /> o rr ft >m 1%ty <br /> From r= tQ 4/2 „ <br /> i <br /> Type and am or shot or well nag Srzd of vm*d t <br /> Ffescrihe lout ��LfX 1?i1 Ca <br /> (7) PERFORATI <br /> Type of perforator used + <br /> Size of Vtura=lops 3 r to lea th h Je <br /> �'r0II1 ec sn itdw GYeti. rqL A Rnw.pat It, il <br /> (8) CONSTRUCTION- „ <br /> Was a surface sanitary nett provided? �f+'Q'es ❑No To whit depth 1, _ <br /> Were ear tcrara reeled a6alnst potlaslaa} (a;'tres ❑ b If ya,note depth of strata „ <br /> From <br /> - it to�y � ft <br /> .1 3 } <br /> Method of SealuxgeC r`t r Work started t9 Completed 1� <br /> (9) WATER LEVELS; WELL DRILLERS STATEMENT <br /> r ,a 41 � �f' T'bis well was drilled under my lurlydretion and ekes reporf it true ro ike best of <br /> Depth at which water was&fat hand <br /> Vy JrnrrwFedgeand Eei'1ef <br /> Staadint laud befOra peslorttlaa s <br /> taIr lord after petforattn6 s'{ ,, . c {.+ s' e j s (person,fir �r cotparatton) a Type or prsnsrd) <br /> 0 0) WELL TESTS: 'r4 <br /> i <br /> , • e <br /> Was s pmmp texe ee.dr? ❑Ya air.,If 7a,by whom?' q� <br /> Yielde nal/min with �'�' !t draw down after ,��"� hri [$[GHAn] ,� _•..y,fttG- _„, ___ _ �., _, <br /> _ ' Well Drifter <br /> Trrnpsrature tf Wates r_. Was a ehamlesl ena(psis made? Q Yes E}fia^ A1 _^ ryM/ s <br /> _ Li�t>sc No. Dared <br /> Wu alt,=tie lot made,of well? ❑Yas E21W' aa609 3 v4 LOM QUM©aro DWR FORM No 245 JHKV m 54) <br />