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ORIGINAL WATER WELL DRILLERS REPORT o o Not <br /> 4296 <br /> Fill In <br /> File Original,Duplicate and Triplicate with the (Sections 7076,7077,7074,Water code) <br /> REGIONAL VVA'I'FR POLLUTION <br /> STATE OF CALIFORNIA Scare Well No_ <br /> �TROL BOARD No L`4-1- <br /> r appropriate aembrr) � Ocher Well No _ <br /> (I T) WELL LOG- <br /> Name Total depth /ze ft depth of completed well h <br /> Address Formation Describe by color,character,rrze of materjal,and structure <br /> ft to it <br /> (2 LO ATION OF WELL: <br /> Owner s number if aay— <br /> R F D trent + <br /> J � <br /> l <br /> (3) TYPE/OF WORK (check)- <br /> New <br /> check):New well [ Deepening ❑ Reeondtnotung ❑ Abandon El <br /> if abandonment,describe materurl and procedure in Item II <br /> (4) PROPOS USE (check) (S) EQUIPMENT: <br /> Domestle Industrial [❑ Mumcapal ❑ Rotary 00 <br /> _a <br /> Irrigation ❑ Test Well ElOther ❑ Cable El <br /> Dug Well ❑ "r, <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE M-s"GUBLE❑ Gage <br /> fi I/taw I04. or of Bore iaC,t /.0 <br /> M It m Wall <br /> I <br /> Type and sne of shoe or weli ring Size of gravel <br /> Describe joint z2 �� <br /> (7) PERFORATIONS: <br /> Type of perforator need„ -- <br /> S11e --of-per in,length b is <br /> �m/� t to ���Q ft T'erf y[r r[IM 'A--- Rows per it <br /> (8) CONSTRUCTION: <br /> War a surface aamtary and provided? •&< ❑ No To what depth zi It <br /> Were any strata sealed agapatt pollution? tl © No If yea,note depth of strata le-71 <br /> From it to it <br /> Method Of Seal-mg Work started rv� Completed r t <br /> (9) WATER LEVELS: WELL DRILLEWS STATEMENT <br /> This well was drilled under my Iurssdwhon and this report is true to the,best of <br /> at which water was first found it my knowledge and belief <br /> dsng level before perforating Is NAME //V 4/1 / xe /�•� '�C <br /> andmit ievel after perforain <br /> tg It (Prison nrm or <br /> cperat— �� i I sped or p�r,n�lrrdd_) <br /> Address- <br /> (10) <br /> ddress(I0) WELL TESTS: 10 <br /> Was a pump tett made, 0 Yet TrNo If yes by whom? <br /> Yield /� gal/min with 01""? it draw down after 1+ brt [SIGNED]_ - <br /> ' � / <br /> Temperature <br /> Dr+ rr <br /> smptrature of water ^fit Wei a chemu <br /> ii aaalynt mads:? [] Yet -Q'IVo LicenseNo- �' - v S/X - - -`1�AJ"'rJ�, � , 1 <br /> Dated <br />