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' �.LJC.H <br /> .r 4R'GINAI, WATER WELL DRILLERS REPORT Do Not Fill Ix <br /> File 049fnal,Ltpllcafe and Tripiicafe with the (sections 7076,yon,70)18,wets cone] N� (16 6 J C 2 <br /> REGIONAL WATER POLLU�T ON W+"I "7 _ <br /> -,CO�1TRQL $UARI7 N.-4— STATE OF CALIFORNIA / i,­' state'Gell No. <br /> .----. ,. <br /> � <br /> "�r>1J DrirN wr>,sjrerJ -Orbit Well No_;` --'---- ----- --'S°`� <br /> OF I) OWNER: ty (11) WELL LOG: <br /> Name G fr. '[)epch of eompletrd well <br /> �+'rCl Total denYh <br /> Address Fnrm orlon: 1)rrrrtbt jy)1070)1,rbrrnrter,sizr o R <br /> �/f�J l girl,e d ex.rrRurr. <br /> II� c1 ti <br /> (2) LOCAION OF WELL: <br /> co <br /> owner's- f, number.if anv— '2 <br /> U �� <br /> R.F.D.of stmt No. <br /> i <br /> t <br /> 3 <br /> (3) TYPE OF WORK (check): 3 <br /> New well Aeepcning ❑ Reconditioning ❑ Abandon ❑ <br /> f f abandonment,describe material and procedure in item 17, C <br /> t f <br /> (4) PROPOSED USE (check): (5)_ EQUIPMENT: <br /> Domestic Industrial 7 Municipal ❑ Rotor• <br /> Irrigation ❑ Test Well [:, OtherEl Cable <br /> Dug Well <br /> (6) CASING INSTALLED; If gravel packed <br /> SINGLE DOUBLE 71, Gam <br /> �-^- ��]] / rr Diameter from co <br /> From it. [r Snip Dia.. I <br /> of Bon fr, ft. <br /> Type and six of shoe or well rind � Size of gravely <br /> Deacribe jointI--�a�. <br /> (7) PERFORATIONS: <br /> Type of perforatpr need <br /> Srze of perforations ItnRth,by I ` <br /> FtYISTl ft.E. k. Perf.per row Rows per it. <br /> (8) CONSTRUCTION: <br /> Was a surface ssoitary aesl pratided? 11 Yes ❑ No To irhu depth jt •, •, +-\ <br /> Were any strata staled against pollution? ❑ Yes <br /> ❑ No If yes,note depth of strata <br /> 1;fOITI ft.to ft. . .. <br /> Method of Sealing C � <br /> Work started' /rr t9 Completed <br /> (9) WATER LEVELS:.- WELL DRILLEWS STATEMENT: <br /> Depth at which water was.Etat fogad O r ft This well was drilled under my jurisdiction and his report is true to the besf 0 <br /> 1 <br /> �_ my knowledge and b `{ T Q ('_ �'�! ('!( S, <br /> ding ierel before parforstina - .. _. ., ft. L l L-t t t.:, t t U s ;'u(t. P lz n f•�? i i'y v a/ <br /> NAME <br /> inn level after perforating ` - ft. <br /> (Person, o a <br /> hr or rrn <br /> Address 5-rOCPC"rON S. GAL11=0RNIA <br /> 10) WELL TESTS: <br /> 7pw a pump test made? ❑ Yes v If ya,by wbvat? <br /> ..--Yield. gaE./min.withft. draw down after hag, [$ICNED] �....__. •---_—»_ <br /> Temperrtan of wager I/u a a:hamical analysis made? [] Yes o N y4 --�/ — - <br /> d <br /> Rani�r?rirric <br /> [or made of well? ❑ Yet - <br /> aro:G 0.47 AOM OWN p Gro DVVR 188 (REV. 344) <br />