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Do Nott r <br /> ' ORIGINAL P WATER WELL DRILLERS REPORT titin <br /> File Original,Duplicate and Triplicate with the (Saetianr 7076,7077zoic;'Tatar cadet �r l 'N� 5 5 �; P <br /> REGIONAL WATER POLLUTION State <br /> x- �r>NTROL BOARD No STATE OF CALIFORNIA �`� OtherWe]1Na••-._--__-_----_ <br /> i,{'--• '+r!rppraprtefr strsnbrrj . <br /> { (1) OWNS : (11) WELL LOG: . <br /> ` Name Total depth / 0 _ _ ft._Depth of completed well {t <br /> L Address Formation: Describe by 0or,charec:rr,riar of materiae,end ftrwrfurr. <br /> fr.to ft. <br /> ' 2 LOCATION OF WE —Z <br /> l County Owner's number,if my— <br /> K.F.D,or Scree <br /> LAa 1:41615X <br /> (3) TYPE OF WORK (check): <br /> t' New well IX Deepening ❑ Reconditioning ❑ Abandon ❑ <br /> Lif abandon"tent,describe material and procedure in Iters 11, <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: <br /> Dome§tic 15fl -Industrial ❑ Municipal ❑ Rotary I f, <br /> Irrigation F-1Test Well :1Other InCable El <br /> Dug Well ❑ <br /> (6) CASING'INSTALLED: If,gravel packed <br /> SINGLE IN DOUBLE71 Gage <br /> - Diameter, from m � <br /> From ft. ro fe. Di­ Wsll of Bore ft. -- <br /> ro 77- <br /> Type and.i.t of ahoy or well ring / �yi� Size of grYvel <br /> Dercribe joint ,. <br /> L (7) PERFORATIONS: <br /> Type of perforator toed <br /> Size of perforations in.,length,by in. n •• <br /> From (t,sn (t. Parr.per row R-tt•s per it. <br /> a <br /> (8) CONSTRUCTION: <br /> — --- -- — _ ��� �� <br /> L ala,a-rface taniraty teal proTidedt ❑ Yes ❑No To what deprh;, £t. ` J ,rt..i <br /> Were any strata tesled agafast pollutions Yes ❑ Ne rf yn,note depth of strata <br /> From ft.to ft. <br /> D .. Ze>V <br /> Method of Sealing � V7ork started ,? 19 4�c' Compacted �, _of� 19 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Tbir writ was drilled trader my jurirdietion acrd This report is true to the brrt of <br /> Depth ac which water was font found ft• my area ltd a brlie. ) <br /> ` -•,ding level before pe,fo tins ft. y ' '. l!"� i t e- _ �•' _ <br /> { Jing inset After perforating it. N _ IYer n nim,o urptracinn t rT`j�p pr 7e <br /> Addres <br /> (10) WELL TESTS: <br /> Vrar a pump teat made? 0 Yes ❑ No if res,by whom? <br /> Wall IMilfrr ..– – -- =– <br /> Yitidi gat./min. with ft.draw down after hra. 3 —s <br /> ( Temperature of water Wso a chemical amlys:s madai ❑ Ter ❑ No ------ <br /> - Dated—•----_ L9-- <br /> V^a,electric Ing made of weft} 0 Yes 0 No - •- a _---_ _- _ ,. <br />