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1771 x- <br /> x <br /> ^t 3 F fiilu�F .�< <br /> ORIG[NAL rP WATER WELL DRILLERS REPORT � `Do Not FillI�iY` *4 <br /> File Original,Duplicate and Triplicate with the (Secuona 7071,7077.747411,Water code) 6f',!H lr 9 55A6 ri 9 <br /> REGIONAL WATER POLLUTION Statc Weil Na_ � _ <br /> CONTROL HOARD No STATE OF CALIFORNIA J�{ <br /> isrt epproprralr eaaabrr) / (� (� Other Well No »_— <br /> ' (1) OWNS (11) WELL LOG- <br /> Name Total depth/7d fr Depth of completed well {t <br /> Address Formation Drier)be by roPor cberrrsm,is.e til e+atrrra7,�xs rtrreels rr <br /> 1 it To ft <br /> (2) LO ATION OF WETZ- 7n <br /> CounTT r Owners number rf any-- <br /> ' R F D or Srrcr c _ � <br /> C <br /> (3) TYPE OF WORK (check). , <br /> ' New well V Deepening ❑ Reconditioning ❑ Abandon ❑ <br /> s <br /> If abandonment,describe material and procedure in Item I I <br /> (4) PROPOSED USE (check) (5) EQUIPMENT- <br /> Domestic Industnal ❑ MumcspaI [I Rotary <br /> Irrigation ❑ Test Well E] Ocher C3 Dug <br /> ❑ <br /> Dug Well ❑ <br /> ' (d) CASING INSTALLED If gravel packed <br /> SINGLE IX DOUBLE L—] Gage <br /> Diameter from to <br /> From it to it Dtam Wall of Bore fe it <br /> Type end flit of shoe or well tins Stae of grad f 1 <br /> X f� <br /> T}crenbe!aa[ . <br /> ' (7) PERFORATIONS <br /> Type of perforator and IQye.� ......_....---•--�-- <br /> ' Size of perforatlonr tn. length by in <br /> FFrom ,. <br /> roft 'r, ft Perf per row R­per ft <br /> ' (8) CONSTRUCTION <br /> Vm s surrsce aaartary teal provided? 0 Yea ❑ No To what depth it <br /> 1 <br /> Were any strata sealed siunst pollution? Yes O Na If tea,note depth of sttata <br /> ' From It to ft <br /> D a e� <br /> Method of Sealing Work Stir ted ` G l9 G el Comptetrd <br />' (9) WATER LEVELS- WELL DRILLER'S STATEMENT <br /> Tbrr well was drilled under way luradsetion and this report is true to the brit of <br /> Depth at wh.ch water was first foead fe <br /> my kno led and bele <br /> f,d,.g leva1 heforepeeforatrng ftit 1w <br /> N # <br /> ,4ag levet after perforat,ax ft <br /> { rr n dem or carposeat,on) <br /> {10) WELL TESTS: <br /> Dia a pump uas trade? ['] Yea Q Na IE ya,by w6ater7 �„„ <br /> his (SIGNED] <br /> Yteldl ...- ..._.. <br /> Cal/coca wttls fc draw down after 1♦r1111nAfn <br /> r,traperacure of water We-a chetnical msfym made} 0 Yes Q No License No__ Dated <br />