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At LOCATION NOT CHECKED <br /> j ORIGINALWATER WELL DRILLERS REPORT" Df? Not F:II lit <br /> File QrlginaI,Dapikale and Triplet9to wish the ) N U 14296 <br /> (Secttoas 7076,7077,7078 07attr Code <br /> REGIONAL WATER POLLUTION carece Weli No,� <br /> • CONTROL HOARII No- STATE OF CALIFORNIA i�, Su --- <br /> rj ap <br /> (I,rreproprtaft apmbtr) 7 T'1 =VCR No w—s f��? j,70 <br /> O ER: (11) WELL LOG: <br /> Name �V CA0 4d/ Total depth /ryC� ft Depth of completed well <br /> C� ra�© fr <br /> Address U &. �� FoTmatloat Drlrrlbt by rotor,ebsrortrr,aur of meeerial,end rlroqurr <br /> e <br /> It to ft � <br /> (2 LO ATION OF WELL: onveg <br /> r <br /> Owner a number.tf any-- 'y <br /> tree[ L r<A ! <br /> (3) TYPE F WORK (cbecA): <br /> New well Deepenutg 0 Recondu,onntg © Abandon El <br /> It abatadostmeal,describe Inaierml and Procedure to Hem I I ' <br /> (4) PROPOS3D USE (obeck): (5) EQUIPMENT: <br /> Domestic Industrial ❑ Mumclpal ❑ Rotary " <br /> Irrlgatlon E] Test Well ❑ Other 11Cable ❑ t 1? r �, far <br /> Dug Well ❑ C O*I 6' <br /> (6) CASING INSTALLED- If gravel packed 6� <br /> SINGLE Mr"DOuHLE 0 t A �,6e <br /> From 0, .,&,of I ft iF f a.. f',—z Wel} olf 8oter���iftm��� <br /> Type tad 0—of Aas or well nee Sad of 8raveli <br /> Daunt Twat <br /> (a) PERFORATIONS: , <br /> 'type of ptefentor used <br /> Sf7,e of eutaritla.w L Ia,It.lub by In <br /> feFerf per rox Rawr per it <br /> (R) CONSTRUCTION: „ <br /> bra.a surface saaltary"provided? {t3 'a Q No To what depth (t <br /> Vete any atrate sealed agsawt pollution) wly., ©No If yes note depth of strata <br /> From It to ft <br /> Method of Sealing (� Work etsrtad r Completed 1 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> r This well War drdled umder away}arisdretion and this re¢ori is trite to the bell of <br /> Dtpth at which water vas first fwud - rJr It my knowledge and belted <br /> Sn11dW6 level before perforaeins (t _NAME w®1 pAz <br /> andln8 level after perforstaa8 ' it (ptrionfirm corporatiun) [Typrd or gr,nsed) <br /> Ad_drar a 16 ,— <br /> (10) WELL TESTS• � <br /> V.i a pttmp tetr msdtT 0 Tel eNo If it-,b7 wham? <br /> $IGNEQ <br /> gal/rata with any it des:down alter We I Driller ~~ — <br /> Temperawre of serer _�' wa.a Aemt-I analy..s msdc! C1 Yrs LTMO License No/—, <br /> Was eleattte log made of well? 0 Yea .fir`a 05102 a 24 pots Quits©spa DwR FORM///NO 240 ?RSV 3 <br />