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ORIGINAL �• V1��� VQ _ � <br /> File Original,Duplicate and Triplicate with the f /! SHEET 2 <br /> .r D1741111 OF WATER RESo6vcES <br /> V' O BOX 1074 <br /> SACRAMENTO 5 CALIFORNIA <br /> �4y Gli �yUt`7 <br /> WATER WELL DRILLERS REPORT Do Not Fx11 In <br /> l (Sections 7076,7077,7078,Water Code) State Well No <br /> Other WeII No _ <br /> Region <br /> J� <br /> (7) Perforations ^rte <br /> Type of perforator ustd _ <br /> - - - -- --------- - -- - - - - - - -- <br /> Perforated it to -it Hole size _ __No of holes <br /> ---------------------- -- --------------------—---— - <br /> (8) Water levels (9) Well pumping test <br /> Depth at which water Date of test____'"2 2By whom________d r 1 1ler <br /> ---- ---- -- ------- - - <br /> first encountered L ft Depth to water when test started ___g <br /> P ft <br /> Depth to water G P M at beginning of test <br /> before perforating __ it Drawdown from standing level _ it <br /> Depth to water G P M at completion of test <br /> after perforating it Drawdown at completion of test__________________ _____ __ -------_ -_it <br /> Note any change in water level while dnlling Length of time tested__ __ ___t't <br /> -- - - Temperature of water -Was gas present in water? ❑ Yes ® No <br /> (10) General <br /> Was well gravel packed' _____ SLS Size of rock Thickness of pack <br /> Was a surface sanitary seal provided> <br /> Were any strata sealed against pollution' ❑ Yes ® No If yes, attach detailed description <br /> Strata sealed - - <br /> Was analysis made of water" ❑ Yes ❑ No If yes, attach copy a r 11 1 e r S field %e S-t ppm <br /> Was electric log made of welP ❑ Yes ❑ No If yes, attach copy <br /> If well abandoned, was it plugged and sealed",----------------- __- - -- _--------- ---- ---------- --- ---- <br /> Method of plugging and sealing --------------__ -- __ ___-_ t { ►L s USE- ONLY <br /> {11 Location (12) Time of work sig :J► <br /> Lortb Section No _e_ Work started date Completed date <br /> Township 1_3 Date of this report 3—1 7-5.3 _ <br /> 4 Range <br /> Base &Meridian_- WELL DRILLER'S STATEMENT <br /> Show location of well in Sec- This cell was drilled �ex�l t and this <br /> cion, thus (X) report is true to the best of any knowl yge anrf-P-hef <br /> Distances to section lines from l ' <br /> well, N or,,'-6?`d-e_ f JS[rhrED] <+ s+r <br /> � Wr1I Drdlrr <br /> and E or3V/J'-0 U it <br /> Show location of nearest By <br /> known well, thus (0) License No AkYl^4�i Classification <br /> I MILE Distance to nearest known <br /> well _- it Dated <br /> D w R FORM No 246 REGIONAL WATER POLLUTION CONTROL. BOARD COPY 213721 30 MM QUIN s10 <br />