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i' ++ Aja c 'O r / <br /> -Y J J <br /> WATER WELL DRILLERS REPORT r Do Mot i4l lie- t- 1 <br />•� ORIGINAL 'A rtit+s a <br /> File Original,Duplicate and Triplicale with the (sectteae 70746,yon,7071,Valor ceda) W AN? - 9 <br /> REGIONAL WATER POLLUTION State Weil No 1 <br /> STATE OF CALIFORNIA - <br /> CONTROL BOARD No � � � � Other Veli No <br /> ere approprlalo owrab") <br /> OWNER: (11) WELL LOG- <br /> NameName /� <br /> Total depth ZT d it Depth of completed well T ft <br /> Address Formation Dnrnbr by color,cbnaeW trze o/walsr+af and r1rairlrre <br /> ft to it <br /> r <br /> (2) LOCATIO OF WE <br /> Crsunty Owners number 'it.— 4_2 <br /> R <br /> iaav-- <br /> R F D or Skd.rt Aa <br /> D �D <br /> O <br /> (3) TYPE OF WORK (check) <br /> New well X Deepening ❑ Recondizionmg © Abandon Cl <br /> it abandorrmerrl,describe material and procedure its Item I I <br /> (4) PROPOSED USE (check) (5) EQUIPMENT: f <br /> Domestic ❑ Industrial [] Municipal ❑ Rotary ❑ _ <br /> Irrigation 71Test Well ❑ Other 13 Dug <br /> Dug Wt:Il ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE X DOUBLE 71 Gast <br /> Diameter from <br /> or to <br /> From ft to ft Disco Wall of Bore is it <br /> _ 0 Zvi' !b !•y <br /> Type and r of+hoe or well rear X K/a S,2t of era-0 <br /> Dacnbr Iwnt <br /> (7) PERFORATIONS. / <br /> Typt of perforator wed <br /> w <br /> Size of perforat,oaa / fenRth by m s7 <br /> From rt r t Pctf per rawRrv.per fr <br /> y <br /> (8) CONSTRUCTION. <br /> W.- s surface s.n,t.ry real provided? ❑ Yn L] No To what depth it <br /> Vert any.arta r.sled a=unt polluttoo? A Yes ❑ No 1f yet note depth of rtrail <br /> From ft to tr - --- 12. .- , _ <br /> Q <br /> Method Of Sealing gftee. Z# S nt&& Work started �4 � 9 '- completed <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> This well uai drilled urrde.my lvrlldictron and this report a ?rut 10 the best of <br /> Depth at which water was fiat found it my knowledge and b�uf �r <br /> dies level bcfota It -`r L ?'y 1 <br /> Pcrlorauaa NAME <br /> J ~i 1 <br /> laR Irvrl after perforetina to (PrrV firm . zormrar,acal J tT>rrd or!1e•1rIJ <br /> - ——" Address <br /> (10) WELL TESTS- <br /> Val <br /> ESTS•Val a pump We made? ❑ Yea ❑ Ne if yas Illy whom? - <br /> Y-1d til/mill with fr draw down after hes [$ICNLD} <br /> Well Dr?Nn <br /> • � r J - <br /> 7atnpentvre of water Val a chemical aad'lns made? ❑ Ya ❑ No License No._____. — _ Dated.. <br /> .• L <br /> W30 rlretrtc Ina made of well? 0 Y. 0 No 17020 4 87 e0L akiIN Q aro DWR 180J?eav 3 est <br />