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oR <br />° . <br /> DIVISION OF WwEuxESvuxCEx SHEET 2 <br /> P 0 BOX 1079 <br /> WATER WELL DRILLERS REPORT Do Not fill in, <br /> State Well No <br /> (Sections 7076,7077,7G78,Water Code) <br /> Other Well No <br /> (7) Perforations. <br /> Type Of perforator used----- '---'--- ----- ------'--- ------'- ' <br /> Perfor w6_-' -' �� �o- f� I�n&::oc '--' —— ------- -' --' - <br /> . -------- ---'- -- '-- '— ` '- --- ---'--'_--I�o of holes '- - <br /> ----- -__---- _ ~ 11----- ---------_--~ " ^' ~ . .^ -- <br /> . --------_ ~ '. '^ .. ~ ------_-_-_--_--' ---- -- <br /> ----- <br /> ' <br /> -_-__ -_-' _---''---_-' ' - --------_ .. ~ ~ <br /> . --_ --' ~ ~ ~ ^. . _- - ------ ---------- -_----- _ <br /> ----_---- ---' --' -------- '- --- ^^ ~ ^' <br /> . - '--- ., ~ ~ ~ ~ -- - ----' -__-' - -- --_' <br /> --_' --- --- _----_--_--- -- -- - - .. ~ ° <br /> ---- '-----_---- -- <br /> -- <br /> ~ .. <br /> . ---'- -------'-__ .' °--.-'-------_'--__--" ^. " '- ------------- __-- .. ~ .. ---.-_-_----'--- <br /> .. ., ~ ^. --__---- -'----'_'---'_'-'-' <br /> �-'_'_'--_---- -__-_'_------'--- -- '-- '-_------ .^ ~ ° <br /> ^. ~ ~ -- -----'- ---'------ <br /> - -___-' ___-- __' '- ------ ___ ~ � _ <br /> ^. " ^^ _-_ ---_-'-_ -_-_-- <br /> - --- ------------ ----.-- " ° ° __'--.-_- ' <br /> (8) Water levels ( <br /> 9) Wellgo,np,ng test <br /> Depth xtwhich water I)utr vftest------------------Bywhom <br /> -'---------------- ------------- <br /> first=ucmmuu:ce6 -__�--- --'_-'-----''-- -fc Depth towater when z*nt started --' �-'---''-'----' --'---' <br /> ft}q;ch to water G P M at 6rsozuug of tr'r_ _- - --'------- ---- --' —'-- <br /> 'before perforating-- -�� }rup6��u6muoc�oJog level _- ------ -- '--' --- ft]«pt6u» n^ter G P M accvopletiun "f *-------------------------------- <br /> -------—----- <br /> after p <br /> e <br /> ,to-ra-ti--n_g--- <br /> ---- <br /> '_-_------------ <br /> - ----f'-r� <br /> -_--Iz <br /> xn�'-�-6 o- <br /> .-u-at <br /> 'c-n'--m--pl'--e-'t-m'--�o/of <br /> ' <br /> test <br /> '--. '.-''---' <br /> _'-------''_--�--'--'�- <br /> ' <br /> `�^--'' <br /> --- ---- <br /> - <br /> -'-'-- <br /> --� <br /> '- <br /> -`--'' <br /> rNom: »oyc6uogv/uvatmr1=,olw6ilc6riD`ug Length oftime tested---------- __ <br /> ___ _____ -------- _----------__ _---------- Temperature of water- -_ ----------------�--- '- <br /> ------- <br /> Was gas present in =uu:r� 0Yeu [ N* <br /> (zo} General <br /> 'Was well gravel packed Size ofrock----_ - - -'- T6/ckocoofpack '--'W� usurface sanitary seat provided) -'- -- -'-'-- ---'-'-' -- ----- -'- -'-----'----_-' -' - --' � __- --'- -- <br /> Were any strata �a�d against pollution) [ Yes F1 No If yes, attach decuJwfdr description-,o*u�d <br /> Was analysis made ofwater) [] Z= [I No If yes, attach copy <br /> Was*l,cr�c�emade of �J ? [ Yes [] NmI{yes,2ttao6copy <br /> if well abandoned, was it plugged ao6 _ _ '----- _-_ --—_'-'- -'--- ---- <br /> Method of plugging and _ -----'---- <br /> (l1) Location- (12) ] unewf �ork. <br /> mo,/b Section No Work started du,z''�- omp\e�6 date 3-r204.1 <br /> �x� *f r6., repo <br /> Tunoshqp rt 3 <br /> mxug�_- __ <br /> Base&Meo6/pu� WELL DBULL8R'S STATEMENT <br /> 86unlocation of well in Sec- <br /> This �r� voxdn�� uv �r m ' ''�J'rtmw and I6/,� <br /> tion, thus ( {) report /, /,�, to the botn/ my knowledgepd6x�,/ <br /> Distances to l vm twell, N or 8ft [Smmsnl S <br /> & Motor Work <br /> audEocW__ �_E f t Well <br /> S6up \ocuc/oo of oeacv,c - <br /> known neU. thus ( J) �~-6�__ C-57_ <br /> I MILE Distance to nearest known License No C)axm/ cuuvu <br /> ' <br /> � <br /> well 6 I)uteJ <br /> o ,vn FORM NO 24* REGIONAL WATER POLLUTION CONTROL BOARD COPY ,=,,, �~.~....~� � <br />