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`LOCATION WT CHECKED <br /> ORIGINAL WATER WELL DRILLERS WRT lr Do Not Fill rtr <br /> t HI�Orlyingl Dupligte and TNpI{tgh with the fs«ti...7076,7077,7076 Wager Code) 1,� 1 O 7�r <br /> � <br /> RLGIONAL RATER POLLUTION <br /> CONTROL BOARD No STATE OF CALIFORNIA SnAe'Vrdl Nd, <br /> (lr."e.fetr.ate we.abe.) .� ut , t •� 1 <br /> Orher Wei!No._..�!Y 4r .... _ <br /> '1) OWIr'ER (I 1} WELL LOG <br /> Flot ill Products Inc. Tout depth 270 It Depth of eomplgted well 270 it <br /> Address P. 0. Box 810 rermuton Dru+.lw by color c6.r.rbr sew of Material a"O'Neil" <br /> StockEon 6, it ro 24 ft Clay <br />' 2 Sandy mu <br /> (2) LOCATION OF WELL: 32 52 Blue cls <br /> c—y3an Joaquin ovwer a nnmbae if any— 52 54 rave <br /> R F D or sttert%- oft mu <br /> SgUthwest- Corner of Fresno & Chatter an 125and blue clay <br /> Well on h st side of buildIng 125. 130 Sand & pea ave <br /> h servoir and blue cls <br />' Gravel <br /> (3) TYPE OF WORK (check): -A 9A 20L C a <br /> 2nj,. 210 Sand & gravel <br /> ,New well $ Deepening ❑ Recondtuontng Abandon El 21 b 222 Clay <br />' <br /> if irbartdonment dctcrrbe matertol and procedure in Item 1I 222 226 sand <br /> (4) PROPOSED USE (cbeck) (5) EQUIPMENT C a <br /> Domestic Industrial X Municipal Rotary n Sand & gravel <br /> BlUe <br />' Irrgation Test\Y ell I Other Cable _26.6 220C a <br /> Dug Vi'eIl � <br /> (6) CASING INSTALLED If gravel packed <br />' SINGLE ` DOUBLE Gage <br /> Of Dtameter f-om to <br /> From It o it Dtam Wall of Borg it it <br /> 0 270 t G No, <br /> Type and a.re of shoe or west rt.g X 6 Sire of gra.el <br />' Dsacnbesunt Welded <br />' (7) PERFORATIONS- <br /> Type of perforecor used Shod cut <br /> Size of perfentton. lie .a,Itnotth by 1 >a <br /> Frw'n it Perf per row Row,per it <br /> 1 '21-8 266 <br /> 1 r y u <br /> (8) CONSTRUCTION <br />' Wu a awface wastary sea!provided? 0 Yet No To what depth <br /> A O <br /> A <br /> Van eery strata sealed against pollution? ❑ Yet Z No If yes note depth of strata <br /> From ft to it <br /> Is <br />' Method of Sealing Work.Carted ,9 Comp 1i 'f 5 <br /> (9) WATER LEVELS- WELL DRILLER'S STALTEMENT <br />' <br /> Depth of which Macer"s firer fogad Tbts well was drilled rind"any jurisdiction and tbis report is true to the best of <br /> ft my knowledge said beluf <br /> dins 1ere1 br�,.rr ptrforsuas it NAME Clark Well Drilling Co. <br /> w.Itrsl al,ea perforettnR h (Pcraow Rim or cor pies n..n .7 yArd or Mpsrrll <br /> a Addrus gt C <br /> WELL TESTS- _ _ O <br /> Was a pump uat made? Yr ❑ No If yes by.7spalr- P C & C <br /> g <br /> al <br /> Yuki gal/mu with Et drew dews efnr i <br /> Tomn IS>Gx=al <br />' p rat. Meter.1 7rDriller <br /> .,..eltema.ai..arms..der p re. y N. Lrxnse Na_ �.�2 D:Cid_ �� <br /> '151 ,�-�•.-`f' <br /> Ira electric jot trade of well? ❑ Yet No ossa*a 14 IoM*YIN O arc DWR FW-- <br />