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_ _ 1_OCATION NOT CHEGW <br /> 'ORIGINAL WATER WELL DRILLERS REPORT Do Not bail In <br /> • ilia Qrlginal,Duplicate 0nd Triplicate wild the (seettoas 7079,7077,707a.mater code) N? 31910 <br /> nEGION.AL WATER POLLUTION L- <br /> .�» STATE OF CALIFORNIA ""^ State Well Nam.. <br /> ef7rfrxofr. $oARD No Q o well Nn <br /> fftuett approrl•tf xtrmbrr) <br /> ' ` - 1) O R• f` (1 1) WELL LOG: <br /> Name Total depth ,� /rfbr by color,chtr Deptk of earopleted well <br /> Addres6 rm <br /> /(5 • lraat{oat fktcnrrter,rlsf t aster f,end rtrretJI <br /> v ft ro it arEIS <br /> e <br /> '29 .r e• I <br /> (2)tO YON OF WEI•Lt <br /> twee aumber,if any <br /> R p erS tNo- ee dreg <br /> i <br /> (3) TYPE 9]? WORK (check); <br /> New <br /> sye1I �3/ Dapeata8 ❑ Reconditioning ❑ AI4noon ❑ <br /> if abandoomenf describe tnafayfil and kracedure its It—I L <br /> (4) PROPO USE (checA); (5) EQUIPMENTS <br /> Domestic a ndustrial ❑ Municipal ❑ Rotary [] <br /> Other Cable <br /> E] Oth ❑ <br /> Irngatlon Test Well ❑ Du Well ❑ <br /> (d) CASING INSTALLED: If gravel packed f; 0 ori 7D T- <br /> SINGLL�Oual.E 1�, wp to <br /> " �.Me <br /> f � Disntster Erode <br /> I�Coai f: fe Iam Wal! of Bora ft it <br /> t <br /> Type and are of whoa ar well Bina Size of smart <br /> it <br /> Deudhe]sot <br /> (7) PERFOR.A NS• <br /> Yng of perforator aced �'(�" ' ,• <br /> Size of rforatioaa <.� / m leaxth - •� <br /> From fr to ft Perf par row slows per it <br /> (8) CONSTRUCTION: <br /> Wes a surface sanitary sal pcevidedl �•t ❑Na To whas depth <br /> Were any strata realed at"upotienaat a ❑Nq If Tet,state depth of strata ..— <br /> Ftrom f,"- ft " <br /> Method of Sealing 4, work ttatta <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> Tabu well was drilled under mry jrtrisdiction mad tbtf rrport!s frae to the best e/ <br /> Depth se whrth water war first found t..' - fe my krtatuledge Md her,,/ <br /> "Jinx Ind efetr peeforatlax fC�w vv���dewLL.eCCrp..- <br /> trahunr)dins levebefore petforattns NAME 4/P,59 � lrl1 �J S <br /> 17�ptd or pN.trd) <br /> Address <br /> (I o) WELL TESTS- <br /> Was �� <br /> ti7aa a preop teat modal ❑Yet p na If les,by w6om1 T^"� <br /> Yield i .+�`~Est(nun with �---t It dnw down after her [SIGNPu]w {Veil Deli _ <br /> Tetoperatureaf Water Was a chamlc•l anxlysrs medal ❑ Yst [ la Y.tcante Na �«... Dat .r.• _,19 <br /> Was slectrtc log trade of well? [Idpc <br /> Yee [I-M„ + a "IA a se st ou IN Q spo �� »• - - �4) r <br />