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-011161r,AL STATE OF CALIFORNIA SHEET 1 <br /> Tie Drilli,ul,Duplicate and Triplicate with the DEPARTMENT OF PUBLIC WORKS •«,� <br /> DIVISION COX ,pre070 or RESOURCES <br /> -P. <br /> :,. DIVISION OF WATER RESOURCES <br /> SACRAMENTO B.CALIFORNIA <br /> Do Not fill In <br /> WATER WELL DRILLERS REPORT state Well No N-la_�_--q? <br /> �Z Other Well------ _---------------------_.- <br /> (seetioea 7079,rorr,Baro,Water Code) Region---------._-`�� <br /> (1) Drilh (2) Proposed use or uses (check): (3) Equipment used <br /> Name_____ _ _ ----- _-- _ -------- Domestic ❑ Municipal EJ (check): <br /> Address.__ _._ __ _ _ __ Gt10--------.----------------_ Irrigation ❑ Industrial ❑ Rotary �❑/ <br /> ------ _ _..__._.._.__-_._.______ Domestic and Test well E] Cable SAS <br /> License :.S.L_...____. Irrigation Dug well ❑ <br /> _ Other-------------------------'--------------------- Other------------------ <br /> Owaer: ' <br /> Name.._.... , ` ��__- (4) Type of work (check): <br /> Address------- _ s._...____. __ New wellXI <br /> Reconditioning of well ❑ <br /> ----------- ------__-___-_-_.-'_-_. ..-- Deepening existing well ❑ <br /> (S) Well log: <br /> Total depth of well__ ____. ___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 -------------ft. <br /> --- " ------.ff _... <br /> /�-- --- >----- <br /> __---:--:- �_�----- <br /> ., <br /> /-�--� -- --" --�--�! ---- •• kms. �... <br /> ------------- -------------------- EOR OFFICIAL USE ONLY <br /> --------------- <br /> -------------'-------- ---- ----------- >, <br /> If additional space is required, continue on DWR Form No. 246—Supplement, .0 attach to respective report copies. <br /> (6) Casing left in well: <br /> LENGTH DIAMETER SINGLE.DOUBLE.WELDED, Lee. PER FOOT OR BEATING BELOW <br /> Ou <br /> INCHES - OTHER GAGE OF CASING ` GROUND SURFACE,FT.r )T//-QIj�- - ------ <br /> --------- <br /> ------- --------- -------- -------' ------ - ---------------_----------- ----' -`------- ---- ---- <br /> ----------------------------------- ----------------------._ .-----------.-------'-------- <br /> .-------------------- ------- ------------------------------- -------------- ------- -------—------`------------- <br /> -------------'---v-:. ...._.-•--------------- -- -------'-------------,-_-/- '--'-------------..'- -------'................... <br /> Type and size of shoe or well ring___..__.Welded joints—]fJ Yes ❑ No <br /> ` D.W.R. FORM NO, 246 REGIONAL WATER POLLUTION CONTROL BOARD COPY ..n, <br />