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ORIGINAL. <br /> Fife Original Duplicate and Tripllcalle with the SHEET 2 <br /> dIK}SIOM OF WATER RESOURCES <br /> P a sox +o>s � f 1 <br /> SACRAMENTO g CALIFORNIA <br /> . WATER WELL DRILLERS REPORT Do Not Fill In <br /> State Well <br /> (Sections 7076,porn,7078,Water Code) VUc.11l `_=ms <br /> Other No <br /> t <br /> Region -__ ___-_ _ <br /> (7) Perforations- <br /> Type of perforator used <br /> Perforated_ ___ft to-_-_ _ ------- -___ _-_ __£t Hale size ______ _ No of holes <br /> ---- -- ---- --- ---- ------ <br /> - - ---- - -- <br /> --- -- - -- - ---- <br /> „ >, <br /> - - ------ ---------------------- ---- -- -- <br /> - - -- ---------- ------------- <br /> .> <br /> ------------ -------------------- <br /> ------------- <br /> - -- - - - --- - <br /> (a) Water levels. (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 <br /> before perforating-------- ____________ ____ __ft Drawdown from standing level___ ____________________-_______ _____ ____ __ft <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 drilling Length of time tested__________ _________________- _ -_ _- ____________ _ ------ <br /> ----- <br /> -____------------------------------------------------------ Temperature of water-- - ----------------------------------- <br /> Was <br /> ---Was gas present in water? ❑ Yes ❑ No <br /> (10) General: <br /> Was well gravel packed)____ __________ __ ___ ___ Size of rock-_____ -___ __------ Thickness of pack- <br /> -- -- -- -- -- <br /> Was a surface sanitary seal provided)___________ _ <br /> Were any strata sealed against pollution) ❑ Yes ❑ No If yes, attach detailed description <br /> Stratasealed---------------------------------------------------------------- -- -------- r <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 weII abandoned, was it plugged and sealed)-------------------------------------- ---- --------------------- <br /> Method of plugging and sealing---------------------- --------- ------ - - ------- ------- -- --- - -------------------------- -------- <br /> ------------------ <br /> (11) Location- (12) Time of work <br /> C <br /> North Section No ____ Work started date-�/9 ,3`;_Completed date ,� I__f - _ <br /> Township _ _ __. Date of this report <br /> 5 <br /> Range------ -&-4, �=-------- <br /> Base&Meridian_-1 _ _ WELL DRILLER'S STATEMENT <br /> Show location of well in Sec- This zlie)l was drilled under my jurisdiction and this <br /> non, thus (X) report is true to the beast of my knowledge and belie, <br /> Distances to section hnq from Sit��KTON AR�.IATUR UOTOIR MC3. <br /> well, N or S 1_3O0 t!`_ft [SIGNED]_ --______V_ _ <br /> W'11 D,dl� <br /> and E or W­�9 D ra_�f c <br /> Show location of nearest By <br /> known well, thus (0) <br /> License No 7_j.�_O Cl slficanon <br /> 1 MILE Distance to nearest known �, <br /> well ft ba tea �`' ` 19 r <br /> 0 w R FORM No 246 REGIONAL WATER POLLTJTION CONTROL BOARD COPY 3SS72 3 50.oN QUM SPO <br />