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WATER WELL DRILLERS REPORT Do Not Fell Xn f <br /> ORIGINAL <br /> ,T <br /> file Original,Duplicate and TripBeafa wilh the (svvtivar 79fi,7077,70711,Wale cede) 1�1 U 5 5 2_9�� <br /> MQXOXAI, 'WATER POLLUTION � Sara Wet Na; .....••�._!�..? <br /> CONTROL BOARD No STATE; OF CAWFORNIA�l./ �, <br />' �. s - •rcteeppr0pr1r1rtraa3rrl ........_n..;=..•�----- <br /> I <br /> (1) OWNERt (11) WELL LOG: <br /> Name Total depth 4,2> --_ it. -DVp&of C"RV trod wA1 s <br /> r <br /> Address fvrrmaticast Drrafbr by refer,rbgarfrr,ttar of ieatrTfarl,sqd trrrrtnr. i3 <br /> sr.to ft. i <br /> (2) LOCATION OF WELL: <br /> Cavacr owarurt samba.if rear•-- Z= 'Ih <br /> i <br /> . A.F.L,trcSt^rn iVw 9 lJ __- ., .. � - <br /> F <br /> I� (3) TYPE OF WORK (check): r <br /> New well D-mAns ❑ li ecoete itioning ❑ Abandon ❑ h <br /> Raba»dory,ar>rt,&feserf3r woetrisl4rnd proreiiswr ft lfem I I. __ F <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: " <br /> Domestic 4 Industrial ❑ Municipal C Rorat'y � <br /> Irrigarlon'❑ Test Wel ❑, Other Cable 0 <br /> Dug Well <br /> (b) CASING INSTALLED: If gravel packed <br /> 61NGL.EN D0LI6L.E'— Gap <br /> err lx—t- from fa <br /> k # FLOM ft,w ft_ Dim. W.II of 9w. ft- ft. <br /> TTY-vnd size of shoe oe re11 e:a r Size of ara•e11 „ <br /> Darvi6e pant .. -. ' • - <br /> (7) PERFORATIONS. ---- <br /> T71r of prrferataa'toed <br /> i 5.vn of petforarieer� ----_- is..lruKth,by t0. .. <br /> fFM— ft,.m ft. Parf.per row <br /> n F <br /> l (8) CONSTRUCTION.- <br /> VW <br /> ONS'TRUCT'ION:m'v-rarEaer sanitary seal Previdedl 0Y []Na To v>v-t dlpsk <br /> 17m ase+rano aalyd a6ainrt pdfo[ievi QZ'Ya f <br /> [�1Ve !f�,mq depth of ruaq <br /> From <br /> fr.m ft. <br /> : <br /> � hUrbod of Sealing - .F Vark ee-lt-d 77 m <br /> Gapktee _� f 19 t? <br /> (9) WATER LEVELS: G`7� WELL DAI'LLM'S STATP?MENT: <br /> This wdl wart drilltd tradrr,ary jerirdi ipfr Dir xbrt rrfrprf fn,r to i6 ttt pf <br /> + Drp.b at which water rd fine found fa fid,kn ����•���rIj <br /> vaadias level before Pc10earipf !t. NAME - l • <br /> t.nar level after lwfa.-e„z <br /> Address e ! f <br /> (10) WELL TESTS: <br /> + _ W-t.pwav t•rc=&W ❑ Ya 0 Ne If Ira,b9 wham) <br /> F rcEd_ <br /> � t/ <br /> wcrb, it.draw darn deer l.n• �e17 f)rlfin <br /> T-:op-rature of ratu yrs a ehemivi apdyria made? Q Xq ❑No <br /> C•rT rlectria L"saadv pE�.t1P, 0 Tea Q Ns <br /> naza asa aaM GUIN Q 6r0 DWil.168 (WET.9.84) <br />� i <br />