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LOCATION NOT rHtct� <br /> lGlWATER WELL DRILLERS REPORT Do Not Fill is <br /> FileeWaterN° '7012 . <br /> FilrvAL Original,Duplieaf6 and Triplicate with the (seetrona 7o7s,yoyy,7o,,,m <br /> .r Code) � <br /> REGIONAL WATER POLLUTION State Well No <br /> STATE OF CALIFORNIA G / -�z_� } <br /> AMC ONTROL BOARD No 2 Other Well Nal i / �-[--!` _ <br /> srrl approPrr�tr <br /> t ) OWNER (11) WELL/LOG <br /> Name S Total depth `{ 4 Depth of complered well (�'/� <br /> #t <br /> Address f '� Formauoa Dtl—br by rola' rbarar#r rt_e of malas ,sed alruclure <br /> �y0 it <br /> ro �i Et <br /> V <br /> (2) LOCA'JON OF WELL, <br /> County, q/t f/ A Ow."s number if any <br /> D .7—v / <br /> R F or Strret No �+c r� � EE <br /> c r— r 1 J <br /> 3 At <br /> (3) TYPE OF WORK (check): <br /> New well 0 Deepening El Reconditioning 0 Abandon C] 1442 <br /> If abandonmetst,describe materral and procedure In Item I 1 <br /> (4) PROPOSED USE (check) (5) EQUIPMENT Q <br /> Domestic X Industrial ❑ Municipal ❑ Rotary ve <br /> Irrigation [] Test WCII ❑ Other ❑ Cable t�� <br /> Dug Wel! ,Z ;a! A w <br /> (5) CASING INSTALLED If gravel packed �fft <br /> d' <br /> SINGLE DOUBLE 7 Gage <br /> f or D,ameter from to 7 s f <br /> _ <br /> From fa ro tt D— Wall of Bore it it LL <br /> a2 <br /> jF <br /> 7.pe ands a£ehoe or wail-,n /� 5,ze of grave] <br /> Ducrtbe IoLmr <br /> (7) PERFORATIONS' <br /> Type of perxacacor wed <br /> Size of perforumnt 'n ienxch by Z. <br /> From tr t rt Puf pet sow Row:per <br /> (8) CONSTRUCTIONy <br /> `k as. urtacc sad.ry seal pronded? IA Yrs 0 Na To what depth it <br /> mere day strata scaled agunte polluuaoc C Yes © No If-to note depth of'mars <br /> From Lt <br /> Method of Sealm' (,r t77� Work tetrad 9 CcmpIcced L9 rte^ <br /> (9) WATER LEVELS: WELL DRILLER'S STSTV,1ENT <br /> This well was drilled order my)tar rdretlovs and thrt report rs true to the best o <br /> Dept at wbrch water was fire found it ray knowledg prod etlef ,� ,( <br /> Alift-ding eve3 briar'perront,ng it 4-1NAME <br /> i l <br /> 'dmx vd-;ter per£oraonx it ��.' {'a nrmr QrX Q ar pr ltd) <br /> Address <br /> (10) WELL TESTS:�J <br /> Waa a pump tear mailed <br /> [37.2 [A No. If lu by whom <br /> Y,eld pal/min <br /> with ft draw dorn after hn [SIGNXD i';77 d 1CeI)0SKr ,Tempencurc of waren Wad a chamani anslysrs made? ❑ Yrs No License Nopate l , 19 <br />