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OFfIGINAL <br /> rlre Of'oh'rlgr,r"rr1,0,a and relp ur.:tta WK the <br /> DIVISION OF WAT;#fREfOUACES SHEET Z ' <br /> P o Box 107p, <br /> SACRAWZr,jIo S CALIFORNIA <br /> WATER WELL DRILLERS REPORT Do Not fill 7n <br /> - J&j j) (SfItlons 7076, State Well No <br /> 7077,7078,Water Coda) <br /> Other Well Nor!— _ <br /> f r . ,.,ti►r.le�i Region ----- --- <br /> (7) Perfoiai ns. <br /> } Type of perforator used _- <br /> Perforated __12-8--ft, te_ 1,31 __ft, Hole size_,LAb'_1_—1--/-A--No of holes_ peal--ft <br /> ?I F <br /> „ ----- ---a _.- <br /> At <br /> It <br /> a, <br /> ar r, <br /> (8) Water levels, (9) Well pumping test: <br /> 1 Depth at which water Date of test._._ - —By whom—_ <br /> first encountered—_ _ __ -fr Depth to water when test started _ — ft <br /> Depth to water G P M at beginning of test__ <br /> before perforating_ —_�_—____ _ � _ft, Drawdown from standing level---- _ <br /> Depth to water G P M at completion of test.._...,.__ <br /> after perforating_—.. _ _#t Drawdown at completion of test— <br /> t Note iny change in water level while drilling Length of time tested__ - <br /> _-- Temperature of water- <br /> Was <br /> aterWas gas present in water? ❑Yes ❑No <br /> (10) General <br /> Was well gravel packed?..._____ _ _ Size of rock__ .. w ____-...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 <br /> Was analysis made of water? (j Yes ❑ No If yes, attach copy <br /> Was electric log made of well? ❑ Yes ❑ No If yes,attach copy I <br /> + If well abandoned, was it plugged and sealed?...___ - <br /> Method of plugging and sealing-- <br /> (11) <br /> ealing(11) Location (12) Time of work: <br /> North Section No _.__ _______ _ Work started date— Completed date 6/30/41 <br /> .01 Township_ 1_1 ___ Date of this report._6'72Qs1_ <br /> Sto Actoll Range.. _ <br /> 1 Base&Mendr-in__K A________ WELL DRILLER'S STATEMENT. <br /> Show location of well in Sec- <br /> This well ioas drilled render my jurisdiction and this <br /> IN tion,ilius (X) report is trite to the best of »iy knowledXc and belief, <br /> RDistLl <br /> ances toy"tWGW: ies from I <br /> p well, 2q or S --ft [SIGNED]-- <br /> Me and E or W __ Q()it <br /> �R BT F. Show location of nearest By_ <br /> known well, thus (0) License Na 76602 _CllssificaogSC 57 <br /> n <br /> ' i MILE Distance to nearest known / � r"i��� <br /> well _ fr Dated /y <br /> o w A FoaM No 246 i' REGIONAL WATER POLLUTION CONTROL BOAIIn COPY 279721 1*,x.YIN 5r0 <br />