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• OWOINAL, WATER WELL DRILLERS REPORT �,T Do Not Fill In <br /> ( >flle NOW,Duplicate and mpGtale with the <Stcttona 7076,7677,rare,wl�f ater code) 0 96614 <br /> REGIONAL WAM p0 LLI)j,J'ON <br /> STATE OF CALIFORNIA <br /> CONTROL BOARD No.,t <br /> Abd appropriate aambor) Other Well No <br /> OWNER �+ (I I) WELL LOG: <br /> Name _ r L; r/ 1 f f.� rar,I a s ` e/ <br /> m ft Depth of completed well it <br /> Address A(. f [sormx[t�pree Drrrrtbe by 9,001',eberortp,erzt of reafrrreic cad flrAr�t[i�r <br /> (2) QCIITI _N OF WELL: X) <br /> I Cow x C— '. , ah Owner's number if say-- )1 t <br /> r <br /> R F D or Street No r :. !c _� �lM1` ,' <br /> i <br /> t!wt r 3 <br /> Lb o <br /> (3) TYPE OF WORK (check): <br /> New well Decpmteng © Rreand3usintng ❑ Abandon ❑ e' <br /> it sbandonment,detmbe imatertat and procedure in Itrro 11 <br /> (4) PROPOSED USE (check): (5) EQUIPMENT, <br /> Domesnc Industrial ❑ Municipal ❑ Rotary <br /> Irrigation Test Well ❑ Other ❑ Cable ❑ <br /> Dug Well Cl <br /> (b) CASINO INSTALLED If gr;%Tel packed <br /> SINGL@ DOUBLE ` G.Re <br /> .+� 9y. Dumeeer (teat to <br /> From©is to f ft r r� �, Win of Hare fr ft <br /> Type and$ir;of dhee at wall tins 'h S Sire of gravels , <br /> Ueeeube lmnt e ,rAh� <br /> v. <br /> (7) PERFORATIONS. <br /> Tree of perforator t td , <br /> Size vE narfvntivas a length,b is <br /> From is ns it Perf per row Rows per it <br /> (8) CONSTRUCTION: t <br /> Wan a srrfsee unitary seal prvAded? l,Yts Q No To what depth ft ��Uli--$FFt£?a I 1� rt Ong <br /> , <br /> 1 s ell tic r <br /> Were any atnea reeled spetut pollatton/7 Yea ©Ne ]f yes,cote depth of stmt: , <br /> From fr.to / ( It <br /> MBtllOdOf Sellingr 1 /GLC Work started ' t7 r� Completed iI �n c>• <br /> (9) WATER LEVELS: VVLL DRILLEA STATEMENT <br /> This well ai dritted under my)ur der ton and{bar report is true to tb,best of <br /> Depth at which water war Ent found ft. (tri Am-t- <br /> -IL"disiz <br /> e a f_,level Watt perfontans ft r^ <br /> stet level altar prrfor:etaR ft r(Peron fi r{e,or ttdrgar:nunI �-iT Irl 4rr printed) <br /> Addrrae <br /> . 0 d) WELL TESTS: r <br /> Wee a pump un Mandel ©Yea ErNo If yes.by whoa? <br /> Yields gal Irsda With it draw dawn after bra ----- <br /> Ytmptr �-1109 vaat Was a ohs"ol Baal ns Mandel Yt a License f -- - ....t <br /> 'W"elsetrtc lox made of well? ❑ YesNo <br /> 117025 0 57 nom gvlN,&ere <br />