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µ .PIC <br /> ORIGINAL WATER WELL DRILLERS REPQRT Do Kot F:II In <br /> Elie&191"at Dupfleafo and Tilpiitate lnifh the (Serovar 7079,7977,rare,Water Code) N a) � 323_5 <br /> REGIONAL WATER POLLUTION j <br /> • <br /> CONTROL BOARD Na_� STATE OF CALIFORNIA StatewellNo <br /> {or..r a?}eof rLrr:,rerBerJ Otf+er Well Na . <br /> I) OWNER: (11) WELL LOG: <br /> Name 7 'y <br /> Intal depth / it th of eamipl.ted well <br /> Address ft <br /> d For,ettloar nnrslir br color,CAW-Vitt.size of mouvr1ds ead oruclerr <br /> G+ ♦ it to h <br /> Q 41 <br /> (2) LOCATION OF YELL. .__ <br /> County yl•. �rJ ` � Owea'r aectber,tf a <br /> RFD or Street No. Y <br /> w <br /> At J11,11111 iLi <br /> (3) TYPE OF WORK (ckecA): , �• <br /> New wall ❑ Deepening ❑ Reconditioning [] Abandon ❑ <br /> 1f abr7ndonmerai,dtscrfbs ynafedel aJ,d trocrdnrr JA Item]1 <br /> (4) PROPOSED USE (check.): (S) EQUIPMENT: ,F <br /> Domestic 9 Industrial ❑ Mumcspal El Rotary <br /> Irrigation ❑ Teat Well ❑ Other ❑ Cable <br /> Dug Well <br /> (6) CASING INSTALLED: If gravel packed <br /> From �.( l� r pf ooff Rom <br /> Rfrom to <br /> s to L�_Et�jr Dtsm !� 1ga11 [s ft <br /> .� �� r• a ,. <br /> IT <br /> Type end ane of sloe or well t.ag Stu of granit <br /> Duerlhr]cont <br /> (7) PERFORA'T'IONS: <br /> zyp.ef,ertor.rer Deed ' <br /> Size of tferat,om lee ab h ,, <br /> �rWn it to It per( Y.r raw hews per It <br /> (8) CONSTRUCTION: <br /> Was a surface raeusrr real proxidsd? QfYes ON. 'ro what lath ••-x !t. „ <br /> We"say strata sealed ejaiats pellotwut r❑Yn ❑j3o <br /> IE yss,Dau dryrh of:vara � „ <br /> From d It to ar it. <br /> Method of Sealing <br /> Work starred w la Completed <br /> (9) WATER LEVELS: WELL DRMLPA'S STATEMENTr <br /> rhh well was drilled under toy jur4dfefwot Ind this retort is frsre fn he 6slf of <br /> Depth as which weeer was first found ft myAssntpledgeand belief <br /> Stendies fines befots perforating it NAME <br /> adlali 4rn1 after petforades ft ;Posen, .e, or wrponsron J 17�Mrf er ynsretiJ <br /> ' Address , <br /> (10) VVEI,L TESTS: <br /> 'Was a Pump to-made? [)Yes 0 N If To.by whom? <br /> Ytdds RAE/min with It draw lows after <br /> Wt l Arlllrr '.. <br /> Temperature of water war a cltemtuF sualydr malt? [1 YU ❑Ae 4� <br /> License No.__, . — Dated <br /> was electric lett mrde of roll? ❑Ycs ❑No + <br /> erase e.e7 DIM OVIN A wo DWR 188 MXV 3 541 <br />