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t0tAT0,11 NO I lo <br /> W"7701 <br /> ORIGINAL STATE OF CALIFORNIA <br /> Srr>rt:r 1 <br /> Fife Otfyinai Duplicate and Triplicate with the DEPARTMENT OF PUBLIC WORKS <br /> Citi:iarE of wAT� R,� DIVISION OF WADER RESOURCES `- ter' °° � <br /> P O BOX SC7>a <br /> SACRAMENTO 37 tIFOR`'�iA <br /> !1„,,jDo Not Fill I <br /> State Well No <br /> • WATER WELL DRILLERS REPORT ' Other Well No _ <br /> (Seatiom 7076,7077,7078,Water Code) j --�— <br /> Region <br /> (1) Driller- (2) Proposed use or uses (check) (3) Equipment used <br /> Name_---__--___ ___S�.Z .Baker_ Domestic ❑ Municipal ❑ (check)- <br /> Address __________�Ls .u_;_ �:.1L'' ____ Irrigation ❑ Industnal ❑ Rotary Ej <br /> Domestic and Test well ❑ Cable ❑ <br /> License No _1_ f`_`__! _____Classtfication Irrigation E] Dug well ❑ <br /> Other OaOOK _ Other-- <br /> Owner- <br /> Name---- <br /> ther__Owner•Name--__ --_ __----___Robinson ?a rms------ (4) Type of work (check) <br /> Address_____ _________ _ �;? G 2 s___�U ockt on_ . _ New well Reconditioning of well ❑ <br /> -- - -- -- -- — -- ------- Deepening existing well ❑ <br /> (i) Well log: <br /> Total depth of well_____b2 _._ ft Give details of formations penetrated, such as silt, peat,muck, sand, gravel, clay, shale, sand- <br /> stone,hardpan, rock Include size of gravel (diameter) and sand (fine, medium, coarse), color <br /> Depth From Ground Surface of material, structure (loose, packed, cemented, soft, hard, brittle) <br /> ”- ft to --2.rI--------f t h 1 ay <br /> 2silt ^ <br /> - - - - -- ----- - -- <br /> soft <br /> --- ----- - - -- - W yy,, <br /> ra <br /> criarse <br /> -- ------„ „ J-ap-Lu" � <br /> - --- ----- --- - ----- - - <br /> ., as <br /> It additional space is required, continue on DWR Form No 246---Supplement, and attach to respective report copies <br /> (6) Casing left in well <br /> LENGTH DIAMETER SINGLE DOUBLE WELDED LBB PER FOOT OR SEATING BELOW <br /> F`r INCHES OTHER GAGE OF CASING GROUND SURFACE FT <br /> 2 �� . water 'PI—pe 60 <br /> Type and size of shoe or well rung_-#=Welded josnts--❑ Yes ❑ No threaded <br /> D w R FORM No 246 REGIONAL WA'T'ER POLLUTION CONTROL BOARD COPY 239711 w.aM aUJN SPO <br />