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ORIGINAL STATE OF CALIFORNIA SH 39-931 <br /> File Original,Nilllcate and Triplicate with the DEPARTMENT OF PUBLIC WORKS <br /> nIvisIaN of WATER RESOURCES o�y�s�a� �� WATER RESOURCES <br /> P q BOX 1079076, <br /> SACRAMENTO 5 CALIFORNIA ' <br /> Do Not Pill In <br /> State Well No_/ -'v <br /> WATER WELL DRILLERS REPORT Other Well No <br /> (Sections 7076,7077,7078,Water Cade) -VD <br /> ..5 Re <br /> (I) Driller (2) Proposed use or uses (check) (3) Equipment used <br /> Name _�r x �k.-f r «�- Domestic © Municipal ❑ (check). <br /> Address LZ` _ �_ r.� _ Irrigation ❑ Industrial ❑ Rotary <br /> Domestic and Test well n Cable ❑ <br /> License No _-- ______Classification 12': S7_- - _ Irrigation ❑ Dug well ❑ <br /> Other-- -------- ---------- Other - <br /> Owner- ' <br /> Name_-,4 __� ___- _ __ _ _ (4) Type of wor (check) <br /> Address _______ ___ _ _ New well Iff Reconditioning of well ❑ <br /> -____ __— --------------------- ------------------------ Deepening existing well ❑ <br /> (5) Well log <br /> Total depth of well a -__ ft Give details of formations penetrated, such as silt, peat, muck, sand, gravel, clay, shale, sand- <br /> stone,hardpan, rock Include size of gravel (diameter) and sand (fine, medium, coarse), color <br /> Depth From Ground Surface of material, structure (loose, packed, cemented,soft, hard, brittle) <br /> -4?-------_ft to------ ---------f t <br /> — -� - <br /> M <br /> - u r <br /> --- --------- ------------------- <br /> „ <br /> If additional space Is required, continue on DWR Form No 246--Supplement, and attach to respective report copies <br /> (6) Casing left in well <br /> LENGTH DIAMETER SINGLE DOUBLE WELDED LBS PER FOOT OR SATING BELOW <br /> FT INCHES OTHER GAGE OF CASING GROUND SURFACE FT <br /> ---------- ------- ----- --- -------- <br /> ------- ----------- <br /> --- - - - -- -- - -- <br /> Type and sizg of shoe or well ring Welded joints---o Yes ❑ No" <br /> D W R FORM No 246 REGIONAL WATER POLLUTION CONTROL BOARD COPY <br />