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ORIGINAL WATER WELL DRILLERS REPORT u41 irua r1&S An <br /> File Original,Duplicate and Triplicate wdb the (sectloms 7014 7077,70-r Water Code) NV 55305 <br /> REGIONAL WATER POLLUTION <br /> CONTROL BOARD Na <br /> STATE OF CALIFORNIA State Welt No K• <br /> r] <br /> est Other Well N. <br /> epprop•loh number) '.7� <br /> (I) OWNER (11) WELL LOG <br /> Ngme <br /> i 1 cr <br /> Total depth ��U f Drpth of compirted wcll � C it <br /> ddress J- j l ei / ') t Formation Delenbr by color b.,act",ucr ul matmaf ,aid rirp,lutt <br /> ft in ft <br /> Y <br /> t (2) LgCATION OF WELL. <br /> rr <br /> e'ounc7 ' •� -- Owner a number if an— <br /> it F D ar!—!;W,N , d ) <br /> 71 <br /> 7 <br /> ' (3) TYPE OF WORK (check-). y <br /> New well Deepening C] Reconditioning ❑ Abandon ❑ -, //(v I Li <br /> T f abandonment drtcrrbe material and procedure in Item 11 jG 7 U <br /> (4) PROPOSED USE (check) (5) EQUIPMENT: <br /> Domestic Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well [❑ Other ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE IA DOUBLE _ Gage <br />' or Dumrrer prom to <br /> From Fro ,r{c to j.,�_? ft Diam Wil[ of Bore or it <br />%i-:-- -- <br /> Type and r,ze of shoe or well nng Site of gravel ` -----"' <br /> Deacnbe lout 1 <br /> (7) PERFORATIONS. <br /> Tepe of perforator used <br /> Sege of perforauons (m length by so <br /> From Ic m (t Peri per row Rrwr per it <br />' (8) CONSTRUCTION: <br /> Wit a surface nnitar7 Beal provided? © Yes [] No To whir depth ft <br />' Were any scrota sealed against pollution? lel Yes 0 No If yes mate depth of strata _ <br /> Fromt ft to (/� �z <br /> - <br /> Method of Sealing Gc¢.-r Work started _ y?� 14� Comple rd l9�e <br /> (9) WATER LEVELS: WELL. DRILLER'S STATEMENT <br /> This well etas drilled uii..r my )urudictron and Ibis laport is true to the best of <br /> Deprh at which rater was fin,fonad It my knowledge and beltef <br />' d ng level before perforating it 'NAME <br /> Alt level after perforac.ax Et i+-an a in or—'Pcrarm i p.d r 1•+ntrl <br /> Address <br /> (10) WELL TESTS: <br /> Vias a pump oat madea [] Yes C No If ret by whom? <br /> Yield gal/ma with it draw down after his ISttixED} j� _ <br /> Wr reffrr <br /> Temperature of water versa a chetmeal analysis made? ❑ Yes ❑ No <br /> License No _ Dated <br />' Mas al,crric log made of cell? [Z Yes (3 Na gDWR 18a (REV 3 94) <br /> !17G25 8 77 Saai 171N ep0 <br /> Q <br />