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- - Ll. CATION NOT CHFX�t"' <br /> WATER WELL DRILLERS REPORT Da Not <br /> :i{i Irl <br /> 641ile0f1y1 al,DuplFtale and Trlplitafe with the (';"tion,1076,7077,7076 Water Cede) N? 7 0115 .� <br /> REGIONAL WATFR POLI. ION State Wel]No <br /> STATE OF CALIFORNIA P/ <br /> CONTROL $PARD No Other Well <br /> nut!r ro Holt nrembe■ w <br /> i) ONE • (11) WELL LOG: <br /> Name /'f�� //��1(�I�� _ TotsE dtpclt fe Dept6 0[caaoprttrd xtil it <br /> Address Formation, I)esedbe by color,rbererin,she of see/rrlet,a i s?rurlare <br /> it m ft <br /> 19 1419 - <br /> / r <br /> (2) LOCAT49N OF WELL: 7 A/J s 9 <br /> Cawnt� �� S Owner a numbtr,of any-- fes• T.+ <br /> R lr t) or street No, <br /> 5r 1w x"-ex zec <br /> L ' <br /> s <br /> (3) TYPE OF WORK (check): <br /> New ( Deepemng ❑ Reeouchuaneng Q Abandon ❑ C- + <br /> 1f abandon-cera,describe matersal and rocednre'inTftws 11 <br /> (4) PROPOSED USE (check). (5) EQUIPMENT. � <br /> Domestic Industrial ❑ Municipal ❑ Rotary ❑ �� r r f �' <br /> Cable <br /> Irngatton C3 'Test W ❑ell ❑ Other Dug Well ❑� 2 � +'`� T' <br /> (6) CASING INSTALLED, Ifgr�valpacked ,� <br /> SINGLE i, DOUBLE C3 Gess <br /> nr Demeter from <br /> Froth fz m ft Dram Wal] of Bora ft <br /> Typs=ltd size of shoe ar wdl rend Sire of;travel, <br /> Dwcrihs brat / 6 <br /> (7) PERFORATIONS: ' <br /> 'Fypeai perfbca r used <br /> Size ofgerformlontIeoFth by In d 7a^3 1: _,___v srl I lfi 4}3"� <br /> ` r <br /> From ft m it Perf Per raw Rows per it <br /> -a <br /> (8) CONSTRUCTION. ? <br /> Was+sur Gee sanitary ata]pronded? ❑Yet 0,N- Te what depth it b' \ <br /> mora■ey strata steftd a6saatt pollutmn? 1]Yes ❑ No If yet rare depth of strata . • • \ ,� <br /> �� \ <br /> From [t ea It � <br /> Method of Sealing �__ ��` 1/ pork,torted 19 0' Carap[ <br /> YELL DPJLLEWS STATEMENT <br /> eted -� Qr;}9 <br /> (9) WATER LEVELS- ~ c' <br /> Thu t�ctl was drifted under-Y jurisdiction and this repm rs trur to!be best o/ <br /> Depth at wblch pots wss first fotaad ft my knolv4dg/gaud belle} <br /> Se+odtay lend before perforspna —2—t NL l�•l f��' 9k,¢ -� �7r ` �/ L /d��'a�,•- <br /> daaRhidafterpuforatinK fa f !,Jq�T ip�r brm oc or �u 1 717ypr or P-10) <br /> Address <br /> (10) -%VELI. 'PESTS 'q +,✓ 'y� <br /> 'Was a Pwap tear made? ❑ Yes 0 No ri Yet,by whom4rt'--•.�-'.C�'N=--�?�G / _- ..... _- <br /> 1SI6NPD <br /> Ylelde gil/mm,with It draw down alter het 19e11 Dn7rr, �] <br /> Tetnperaturs of v+ster Wal a efi--1 analyse made? 0 Yes No License N4).- -�� `— Dated.. <br /> Wad elrsMC]of made of well? ❑Ya ANo <br /> aaoRa«_ay east quid, Seo ❑WR 198(FtBV 3 SA) <br />