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ORIGINAL Fits Original,Duplicate and Triplicate with the SHEET 2 DIVISION OF WATER RESOURCES R.o. sox 1079 SACRAMENTO 5.CALIFORNIA WATER WELL DRILLERS REPORT Do Not Fjll In a je- - (Sections 7076,TonState Well No._'.: v ----.-_.,7079,Water Code) Other Well No..--------- ------- Region...............------------"--------- (7) Perforations: Type of perforator used--------------'-- -- — -----'---- -' -- - r Perforated-------------------_--------------ft. to------------------------------St. Hole size---------------------------------No.of holta.---'--'------------._.. .. .. .. „ .. .. » ,. .. ,. .. --------------- ------------------ ---------------- ----------------- „ -, ---------- ------------- ------------------ ---- - - -- - ---_•--.-------- ------ - ----- - --------- ,. „ „ „ _ » --------------------------------.. ..-------- - -------.... - ,. » » ---------------------- ---------- ., „ -- - .... -------- (8) Water levels: (9) Well pumping test: y Depth at which watera�a��,{ Date Of test_.------.--------By whom------ ----_ --._.----- first encountered--_Y---- --------------ft. Depth to water when test started-__-___.___.__._-.__----------—----------ft. Depth to water G.P.M. at beginning of test----_.-.._._._—._..---_...__.__--..--.-.-.- before perforating_.._--------------------------------------ft. Drawdown from standing level-------._—__._.____._._._._._._—---------—ft. Depth to water G.P.M. at completion of test__-___----—_-.._-___—___—_—._—._._.�.___ after perforating------------.---------_--------------------ft. Drawdown at completion of test__._..—________________._-.----—....___.ft. Note any change in water level while drilling Length of time tested-------------__----..._—_____-_---------.-------.---._..---------. y- --- -------- -----�----.0.-9-�--_.--- Temperature o£ water_--------------�-j Was gas present in water? ❑ Yes I N No (10) General: TT\ Was well gravel packed?---------rl”' o----------_.-Size of rock------.------------ -----.--------- -_.-----Thickness of Was a surface sanitary seal provided?----__-------------------------------- -----_-_---------'------------- Were any strata sealed against pollution? ❑ Yes)(No If yes, attach detailed description. Stratasealed--------------—------.-----------____-------------------------------------------------------------------------------'--------------'----------------------------------_- Was analysis made of water? ❑ Yes KNo If yes, attach copy. Was electric log made of well? [-] Yes No If yes,attach copy. 1 LVOR OFFICIAL USE ONLY If well abandoned, was it plugged and male-d? Methodof plugging and sealing-.-----------------------------------------------------'----------------------------------'----------------------.-------------------------'- (11) Location: (12) Time of work: Nor �,PSection No......-� _____.. _ Work started date-.�_i __ -_ .ompleted da ...-� j !. ---.._- Date of this report_-.__— .--�_.�--jt.. ----------- � Range-----'------ Base B Meridian....1.'.'.i-'-.- --..-_ WELL DRl1sLER'S STATEMENT: _ Show location of well in Sec- This wejt� *as drilled under my jurisdiction and this tion,thus (X) report is true o the best o m uowle se and belief. Distances to section lines from well, O[ q�.---ft. tJ� [SIGNED]-------- -.-_.—_- ---.._..___-.._____. and E _ft. Show -� Show I cation of nearest B4:: _.. - -- ...---------------------- known well, thus (0). � v i License No �" }} �-_�Cl9sslfication._..___ 1 MILE Distance t.�Q nearest RnOavn / well----3 Ort, 0...-ft�S r r n -1 Dated----- --f'(--------...:_..._ F* . l D.W.R.FORM NO, 245 REGIONAL WATER POLLUTION CONTROL BOARD COPY a•,a•-w a•„awR aw