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r,Ii's -na upiicate and Triplicate with the �} <br />' SHEET 2 <br /> DIVISION OF WATEit RE50UR(E3 <br /> P o Box 1079 <br /> SACRAMf4NTO g CALIFORNIA <br /> - 5 V 1303F1 Do Not Fdl <br /> WATER WELL DRILLERS REPORT /�A <br /> State Weil No—:�_ <br /> t � (� olf"tions 7076,7077,7079,Water code) Other Well No/ _- <br /> .JS 4 J_ Region..._ ----------- --- <br /> (7) Per4,a'tzons' <br /> Type of perforator used-------------------- ----------- --------- --------- ---- - ------- ----------------------------------- --------- -- <br /> Perforated-------------]28----------ft to_____ ___1.�1--__ ft Hole size-J,/Z._J_-2,/_a___No of holes ZZ__;7er!_-_f-t. <br /> ---------- <br /> -- ---------- ---- - ----------- -- --- - --------------------- <br /> ----„ - „ tt „ ,. <br /> - -- - - - - - ---- ---- - - - -- -- -iT----------- <br /> „ - „ ---- + ---------------- „ ------ --------------------- <br /> -- ------------- ------- -- ----- <br /> ,. „ <br /> ----------- --- - „ -- -- ------------ -------- ,> ---------- ----- <br /> - - <br /> - ----- ---- - ----- --- -- -- - „ ., - -- ., -------------- - <br /> --- - -- ------- ------------------- <br /> ,. <br /> --------------------- -------- -- --------- -------- --- ----- - ---- --- ------------- -------- ---------- -------- <br /> (8)8) Water levels. <br /> (9) Well pumping test <br />' Depth at which water Date of test__ ____ ___-_By whom------ --------_----------__------------------ --- <br /> first encountered___-____________ -----------__----ft Depth to water when test started-__ ________- _____________ ____----- _ ft <br /> Depth to water G P M at beginning of test----------------------------- _____________ __ <br /> before perforating_______________________ __________ft Drawdown from standing leve l_-__________________-______ fr <br /> Depth to water G P M at completion of test________ ___________-------------- -------------------- <br /> after perforating________________________________ _____ft Drawdown at completion of test_____________ ______ _ ___ __---------__ft <br /> Note any change in water level while dnllmg Length of time tested ____________________________ __ ________ ________ <br /> - -- -- - - Temperature of water------------------- ---- --------- <br /> Was <br /> -------Was gas present in watery ❑ Yes ❑ No <br /> (10) General: <br /> Was well gravel packed)_________________--------______Size of rock ______ _Thickness of pack _-____ <br /> Was a surface sanitary seal provided –__________ ______ ____ <br />' Were any strata sealed against pollution> ❑ Yes ❑ No If yes, attach detailed description <br /> Strata sealed-------- --------------------------------------- –-– – <br /> --- - -- - -- --------- - - - - -- - - ----Was analysis made of water) ❑ Yes ❑ No If yes, attach copy <br /> Was electric log made of well' ❑ Yes ❑ No If yes, attach copy <br /> If well abandoned, was it plugged and sealed' ______________ <br /> Methodof plugging and sealing------ ------------------------------------ - - -- --------- - ---- ------ ------------ ------------------------ <br /> (11) Location- (12) Time of work. <br /> North <br /> Section No__ _ _ Work started date___________ ___Completed date O/3?/a <br /> e-k j 3.7,y O 1 Township--1._-X___-__ _ -- Date of this report-------61--2815 ._ <br /> 7S-tt. TktO Range--- <br /> Base <br /> ange Base 8r Mendian-R_-A____ _____- WELL DRILLER'$ STATEMENT <br />' Show location of well in Sec- This well was drilled under my jurisdiction and this <br /> tion,thus (X) report is true to the best of my knowledge and belief <br /> Q Distances taUIlQebes from �,� ��/f�� i <br /> p well, X or S--_--�-----f t [SIGNED] rte(/ - -_IV/., �, <br /> �R EF T, and E or 31V____ -00 ft <br /> mitt rr <br /> Show location of nearest By_ _ T_ __ ___ _ <br /> known well, thus (0) 76602 <br /> License No ____Classification'-C-__ _57 <br /> I MILE Distance to nearest known <br /> well_________ ft Dated__ � �_ _ 194s <br /> r <br /> D w R FORM NO 246 �� REGIONAL WATER POLLUTION CONTROL BOARD COPY 21972 3 yn qM VIN SIO <br />