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FIAL PATER WELL DRILLERS REPORT Do Not Fill In <br /> File <br /> Orii <br /> _ le r�gleale puptIceta end Tfipllwfe with tho (5.rti.aa pert,Tarr,port,Qpae.e cads) NY 5.5238 <br /> REGIONAL WATER POLLUTION State Well I�Io.�."`_!•,, ;.....,�... <br /> goy BOARD No._ STATE OF CALIFORNIA _/, <br /> t �- <br /> •dprefrrfsfl AiWarT� <br /> (1) O (I 1) VTLL LOG: <br /> Name Ter.l d .401-0 -ft Aeprl[of cotnNid wol 1.=r-e-.� j <br /> lj. Ad(�l'CSs p•rmraP.: �ruriae ar eotor,rhmoff",0'r of PwHN.r, <br /> kFe.to h. <br /> (2) L N DF WEL <br /> Cam.q Qwaar'a avaaher,if PDT— �� <br /> At,- <br /> i <br /> R.F_D_or Sires P. i <br /> Z <br /> (s) TYPE OF WORKI—ZKZAOI� <br /> 4 <br /> I 1aW wall Rr Abandon ❑ <br /> !f a6andorrr�ael,delersbr vaetcriol rird proeedureln It_nn 11_ __, J ; <br /> ' (4) PROPOSED USE (chick): (5) EQUIPMENT: f <br /> Domestic Industrial ❑ Municipal ❑ Rosary <br /> Irrigation ❑ Test WeH ❑ Other ❑ Dug <br /> ' <br /> Dug well .. ` <br /> (6) CASING INSTALLED: If gravel packed - <br /> SINGLE X POl1Wt.E <br /> Froml off BQ14 <br /> V>'alvti f[_ fu <br />{. TTPe Pad pica of ahm dr>•.It ciale -�� Sire 4f aravr{s .. •" _ <br /> f Aa.o.f6e jefae ,. .. <br /> * (7) PERFORATIONS: — -- ' <br /> T"q of prafOhtw wed <br /> 5120 .f oracioer ka.,]rett5,k, ia_ <br /> 4 Frwn (T.tofe. Yert.pa_.e.• _ R—Per fr. <br /> (B) CONSTRUCTION: <br /> Wet■Swftp.sni"IT peal prorhw? [] Ya ❑ Ne Te w6r depth ft. <br /> were an Brat.NX[ed d"M •• <br /> 1 as polseivaT �Yer [,}No I!Iw-.ora drt+rh a!rrr.r� <br /> From r <br /> M904 of Seaiwed se—A" <br /> .. r .,.... t9 d. t;Pmpletrd t! <br /> (9) WATER LEVELS: WELL D L.ER'S STATEMENT: <br /> j Thh vall war driVed spider my jxrlidiefioct end Ibis report h eruc t;fbc bet!o <br /> DZPA a i bkh water rrn firer'found fro <br /> p ._ ,,,.._ my kxonrl<dgr belf<f. :•^ � ' <br /> .aad:.s laed WPM perf.raei.a fr. NAME ?I/ + t I 7 f�/ T / <br /> .d:at fc+ei after peef."'6't --- ---- "'_ !r. ._ n �=AF—*W r i,�.wiLj 0.-i � .YLl!_-•� rr.WAlt.,---1.i. <br /> (10) WELL TUTS: % <br /> Oar[Pcm,p cert m1ae? ❑Yes 0 No If Tia.157 wlto,nt . <br /> __.._....Yield: 1. — <br /> /n.o.wi[h fro drew d ter <br /> M •'ra■( hra. � pill Dr1Wn <br /> { , Temorcee.ep of v.rer Via+a eh..rie.l aaalrur ma40 ❑ Yw ❑ No - <br /> No <br /> �e,'o ... -BW.........----.19.......... <br /> canx TTa....--.___...............__...... Aare <br /> f t'+.irrrsric IP�t+Wady of wrlft [}Yis �Q - • '> <br /> i{ sn"t+a7#Ow av,n R 169 (SLY.9-34) <br />