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JUN 1 1966 <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Pill In <br /> File Original,Duplicate and Triplicate with the (seestem cors,7077,rope W:cnr Codas NO i 8 O U C l <br /> REGIONAL WATER POLLUTION <br /> ONTROL BOARD No - _ STATE OF CALIFORNIA Sure Well No�77 9E_-j 7 <br /> of approprLte RttasbnJ <br /> 6-9 <br /> Ocher Well No <br /> (1) OWNER- 0 1) WELL LOG <br /> VamNl <br /> TorSr depth ;J r Depth of eamplered well fr <br /> -1�drFnrrna non Desrrtfit by color eharartrr tr-.e of'.terra! —d strueta•e <br /> Gft to it <br /> G � <br /> (2) LOCATION OF WELL <br /> County a <br /> net s.tambtr if any--- �y? / <br /> K F D or S[rert V j 3� yr <br /> At <br /> �/ At <br /> (3) 'TYPE OF WORK (check). <br /> New well Deepening 0 Reconditioning ❑ Abandoa ❑ ' <br /> if aEandonanent,describe material and procedure an item 11 � <br /> (4) PROPOSED USE (check) (5) EQUIPMENT ' <br /> Domestic Industrial ❑ MunlcipaI ❑ Rotary - <br /> Irrigation [] Test Well ❑ Other ❑ Cable <br /> Dug Well -r <br /> (6) CASING INSTALLED. If gravel packed ~ !c <br /> SrNGLEX DOUBLF- 7 Gage <br /> From Er ro or Diameter f om to <br /> fr Diam Wa11 of Bora ft it <br /> rL � <br /> ti <br /> Type and nze of shoe or welt rrng I-- 9,ze of grad } ..., <br /> Detcnbe rot.t !/ c"�t sr <br /> f` <br /> (7) PERFORATIONS. <br /> Tvpe of perfotaror used <br /> Size of perfaranons lengrh by ,n <br /> From !t ra t[ Perf pct row Rowe per it <br /> (8) CONSTRUCTION. <br /> Was a sur:aco nnrrary$cat provaded7 0 Yet No To that depth ft <br /> Wcre any strata sealed against pollution 3 0 Yes AA No If yea,..to depth of aarata T <br /> From ft to <br /> it <br /> Method Work rtarred 7 Cam !need <br /> p to .� <br /> (9) WATER LEVELS: WELL DRILL S STATEMENT <br /> ��� <br /> ih at-6017,61.17,61.1 well was drilled under sny 1rrn3dicfion aid thys report rs frau to for bcst of <br /> eproarer was first found ft my AnowI dg and�ielief <br /> mR level befota perlutattog Et (J bA �s � <br /> 1101, <br /> -01level after perforating it <br /> NAM <br /> s.`� per n Sr ra[tu�r �TYArd pf pnnitsij <br /> ./Jt <br /> (10) WELL TESTS Addte�s <br /> Was a ptasop teat medea [] Yes A <br /> No If yes,by whom? 7 /2 <br /> yield gal/mtm w,th ft draw down after his <br /> /�6�___.7Petl <br /> 7anro <br /> perarc of mater Wt-a chemrul amlyus teadat © Yes ❑ No License No.l A 4 <br />