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Vv <br /> Elle Orlgloal,Dupllraie sad Tflpllcak with the vw n=Lew c y..L ���x71,Water <br /> c sW.vi`� N? 39892 Z <br />' (�NLf4t.e 7076,7077,707 1,Wac4e fade) —_ �— _ <br /> REGIONAL CATER POLLU3'ION <br /> STATE OF CALIFORNIA �/rr( Sc'�Well No.— <br /> CON <br /> CONTROL BOARD No �C "I Z f Irl <br /> "a<terr approprfair atrabar) Other Well No.- f = 1 <br /> r <br /> t) OWNER: (11) WELLr�LOG: <br /> Name ' s von Peters_ _ Total depth 200 it Depth of completed well 200 Et <br /> Address fit o i B ox 1695 Formae.ont Des"ibe by color,character,as-r of teatnld,rad serrrierr <br /> �aat. ro o, a zt . it to It S <br /> C a <br /> (2) LOCATION OF WELL: 3,jigd <br />' Couey,l a n U o a u ulr o—r s number if any— S C'. -I-Ir <br /> R F D or Serest No t e 1 BON Lath row y B1 ue <br /> -,aad <br /> Briggs Re . 56 7-31 up cl a <br /> TIP76, of OTT c1 a-r <br /> G sn and <br /> a� v <br /> (3) TYPE OF WORK (check)• r nnn' <br /> New well 0 Deepenmg ❑ Recondsoomns ❑ Abarldon ❑ 0e sand <br /> � <br /> 11 abandonment,descrrbe material and procedure to lima I1 <br /> (4) PROPOSED USE (cbeck): (3) EQUIPMENT: .- <br /> Domestic ❑ Industrial ❑ Murucipal ❑ Rotary ❑ <br /> Irrigation q Test Well ❑ Other ❑ Du Cable Well <br /> g ❑ <br />' (6) CASING INSTALLED. If gravel packed <br /> SINGLE:Pq DOUBLE❑ Gage <br /> or De.mstsr from to <br />' From ft to it Dfam arab of Bore it it <br /> C T7 <br /> Type sad s,zc of rhoe or well rias Sete of gravel <br />' Dacnbe Joint S re.' -n- <br /> (7) <br /> (7) PERFORATIONS. <br /> Type of perforator used __ i S <br />' Size <br /> of pecfosuwas �) ��� In lensc6b7 3 ra <br /> From R to fr Perf per row Rohr per it <br /> 95 101 <br /> Tr) 112 <br /> 16L 170 <br />' (8) CONSTRUCTION: <br /> Was a surface rantary seal provided? ❑ Ye Sit No To what depth it <br /> Were aay strata a1l4d atataet poiluteon? ❑ Yes EX No If yes,nom depth of strata <br />' From it to it <br /> Method of Sealing Work stuced 9 rL^ `? 19 _ Completed <br /> 9/10/5 l9 <br />' (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> This well wai drilled ander my ?urrsdtctton end this report es true tv the best o <br /> Depth at which water vu first found 27 It my knowledge and belief <br />' snd,as level before perfarataas it NAME C ark ';ell Drilling Co. <br /> odfag level after perforating it tKnon tlrtn,or orperauun, i Typed or pr.ssrd) <br /> Addrpa 4024 E. Charter _Mair <br /> (10) WELL TESTS: rr� S Cicton, Calif. <br /> Va.a pimp ease made? V Yee C] No if yea,67 whoa? P,, G. E. <br /> 19Y.dd 1685 r al/nun with 42,2 <br /> 2,9 ft dra+dova after _ hra [SIGNL'D]��J » ' Well DrWer 9A0/57 <br /> /� /—+� <br /> Tempereture of water ..,. wWasa a6amecal maly.se trade? C1Yes M No Lteerase No 1 660 2_ Due& — 7l 101 5.fJ , 19_ <br /> Cas electric les made of well? ❑ Yee M No 914149 2 54 SOM Q IN(b SPO DWR FORM NO 246 (RSV 3 5• <br />