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A, <br /> n _ 9 0 � b7` 611 - � . <br /> '41 Off1GINAL t WATER WELL DRILLERS REPORT DO Not RU 10 <br /> File Original,Duplicate and Triplicate with Be (9rer,ow 7076,7017,7078,Wacee Cade) N9 <br /> 5 <br /> 1 ,294 <br /> REGIONAL WAT2A POLLUTI(ag <br /> NTROL BOARD No— STATE OF CALIFORNIA/ <br /> � sr:te well Pio�2(_ r <br /> «hY �ry <br /> rs epproprJrtr a <br /> • pnrbrr) f "� Ochot wdI 1u ,1 e-.!— <br /> 401) OWNER: (I 1) WELL LOG: <br /> Name Te121 daptla 2-2--2- itAtptit o1 comPlrrrd waH �'� R <br /> Address Form24ont Dcanfbr by color,sba7mirr,ow al snrtrr?sl sad arrrerare <br /> -_-- — <br /> it to <br /> (2) LOCATION OE WELL: 34 <br /> / f/ "- <br /> Couasy Owner s number,tf aur— <br /> I <br /> -y <br /> APD or 3srret No <br /> I <br /> + �� l <br /> (3) TYPE OF WORK (check): �c <br /> New Wcll'. Decpeamy, tl Reeancituomns t1 Abandost ❑ <br /> It abmsdonmrnt,describe 1n4tsrfal411.4 procedure 1n heirs 11, '446 <br /> (4) PROPOSED USE (cbeck)• (5) EQUIPMENT- / 4C � <br /> DomesticE] Industrial ❑ Municipal El Rotary C] <br /> Inrxgaraio>a Test Well ❑ Other ❑ Cable -�[s- <br /> �' Dug Well ❑ !1 7 0 -�, . <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE�-gj DOUBLE L—_1 Gast , <br /> or DIAL ter from to , <br /> I7MM it.to ft. Dasm Nall of Bora it. ft. <br /> Type and sim of rhos ar well nag Sag of gravrlt <br /> Da+craLa tolnt �� •• f ? 6 <br /> (7) PMt ORATIONS: <br /> Type of per ffosaror Used w✓J✓ tri" i, <br /> SIZC of I l:fatxtront ' —_III_,lenxth,bl tR <br /> From — <br /> Ft to Is Petf PR tea Rout per ft <br /> (3) CONSTRUCTION: '� r I I <br /> Was a surface ttottacy+4a1 proa.ded? ❑Yea 0 No To what depth ft <br /> 'Wm any strata angled apinat pollutsogl Yb 0 No If yes,now depth of strata .^ '� • � "� <br /> From ft w ft <br /> Method Of.Sealing 1�9�r�d '. ^. - 'W'ork started J 194P Completed v i9L <br /> (9) WATER LEVELS: ,-/ WELL DRILLER'S STATEMENT <br /> Thu well was dulled reader 1ny jnrisdictlon and ibis report is true to the brit of <br /> Depth as whichWARE was first found It, >tty Icer pled a 4ud belref <br /> din;level befoce prtfotstans ft <br /> draN Irvel after prrfoaating ft (Person fist,w eatponttoa) f e os br rd <br /> (10) WELL TESTS: <br /> Was a p++mp test made? (a Yes Q No If yrs by wham? gJ J <br /> add gal/ndo with ftdraw down after hn Writ DrllJe7[$IQNEb]��_�� _ �� r A � <br /> -_ -- _---- _ �.. <br /> Tem ----peeacuee of wane Was a dwodeal analyte mad.? Q Yrs 0 No <br /> License Na—Y ___ _ _ _ bated--_ —_^ .,,, _.., <br /> to+t r)rr erlo log mad?of wdlt <br /> Elyse ONO aroxo vs-1 SaM gLla[A ePa AWR 113'a IRCV 3 9141 <br />