Laserfiche WebLink
LOCATION NOT G' iwaw <br /> WATER WELL DRILLERS REPORT a o Ni423 <br /> Fill In <br /> fila Original.�llplicits and Triplicate with the (Sections 7076,707Y,10131 Water cads,) <br /> REGIONAL VATER POLLUTION state VCH No <br /> CONTROL BOARD STATE OF CALIF7. <br /> ORNIA <br /> CONTROL <br /> r (laasrl approprlalt tram&r) Other Well No <br /> O R: 1 (11) WELL LOG: <br /> Name Total daprh ft Depth of eampltted well ft <br /> Address ,, rocasatiom clef) M colo,cbnrrlrr,site of mar al,and rararlsrr. <br /> t ft w fr <br /> set <br /> ff eAL t <br /> (2 LOCATION OF WELL; <br /> (,_jllwmt s a4mbtr,1f <br /> A P D or rut No <br /> (3) TYPE OF WORK (cheeA). <br /> New well 93"*"' <br /> Detpeamg ❑ Recdndiuoiung © Abandon <br /> 11 abandonalent,describe materral and procedure in Ifesn 11. <br /> (4) PROPOSED USE (cibock): (5) EQUIPMENT: ' <br /> Domestic Industrial D Municipal ❑ Rot ry M--,Irrigation 0 Test Well ❑ Other E3 Dug <br /> El <br /> Du Well ❑ ' <br /> „ <br /> (G) CASING INSTALLED: If gravel packed <br /> SINGLE grs"Ot)i3LE 0 g, w <br /> � �� Dlaeaefer � fraan to <br /> Froman to lel-elft. m���[L��I of eoke <br /> r <br /> S <br /> o. Al1 <br /> Type end site of Am or well sfaj Stze of xrarclt <br /> Describe)einea <br /> l (7) PERFORA I NS: .. <br /> _ Y�pe of pnforater aasd „ <br /> .r <br /> S17e Of ufondeas• in.,lea th b - ' <br /> ft Net pet raw Rawl per it <br /> H w � <br /> (8) CONSTRUCTION: �� , <br /> War a surfaces itis sul Tided? � p <br /> en y pro [t Ha To whit depth �' �ft <br /> Were any strata exceed a3sinn pollution? at ©Pro If To.note depth of swan <br /> ,From fT to it « <br /> Method of Sealing G wary catered 11 ` 19 Completed <br /> (9) WATER LEVELS: WELL DRILLIMIS STATEMENT- <br /> TM wdl was drilled under my jurisdiction and Ibis reporl fs trate to the best o1 <br /> Depth ac which water wan tiers found- -_- {J t rsy kitawTedge and bellef <br /> staadeas level before pesforatin3 S y F{f�: NAME .l� yf'Y _ �1�.s Z <br /> tdtoit level afur perforating i t ft — — �Y� ( e a ,firmlCLrpotsnonY ( flYOrf or/prlaled) <br /> , <br /> Address <br /> (10) WELL TESTS- r <br /> Was a pump tear made? ❑Yna If yes,by whatol t <br /> Yields qal./msa with �-it,draw dodseafter Well nsu r <br /> Tnopnaiure of water i_-- Was a chemical analyses evade? ©yea 9— License I0.. f�� �G. f Datedl -l-- a) <br /> was alectrk lox snsde of wail? 0 Yes n UdI10 3 34 50M quaff ip aro DWR FCAid NO 246 IABV 41 <br />