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LOCATION NO 39-722
<br /> a ORIGINAL STATE OF CALIFORNIA . (-I1 SHEET 1�
<br /> File brlginal,Duplicate and Iripllcate rrith the 09PARTMENT OF PU6LIC WORKS
<br /> ®ivislON of 079WATER REsooRrEs DIVISION 4� WATER' RESOURCES `S K I s s - (S , t
<br /> $ACRAMEKTO S.CALIFORNIA
<br /> Do.Not Fill In
<br /> WATER WELL � 0 RS PORT State Well No
<br /> ] �®/�j Other Well
<br /> !
<br /> (Seatto:ls 7076,7 7;x��,�t� ode) Regio
<br /> (1) Driller: r (2) Proposed use or uses (check): (3) Equipment used
<br /> Name ",.d�_ 'P `s ,� e`? Domestic ' ElMunicipal [j (check):
<br /> Address— _ua' �' �`3 °'—-4 Ze
<br /> .? rigation ii Industrial ❑ Rotary ❑
<br /> 't,� tic and Test well Q Cable +��J
<br /> License No. ^• .. Classification -- r PIrri ation ❑ Dug well []
<br /> OderOther—
<br /> Owner; _
<br /> N
<br /> ame_._tt'3���_..._ _�.• e�P.-�.. ($) Type of work (check):
<br /> dress,, '�-a- , ,' +I -_ New well [�j. Reconditioning of well
<br /> _ _ Deepening ex�lsting well ❑
<br /> ilk f�f 'I✓' o rye. v rti ';`4 �'>�,.+'�/ ?s =-�1�r'r1 /✓ % y
<br /> -
<br /> Total depth of well!f�t: vd-ft. Give details of formatio 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 /> to._.�,1( ft.
<br /> '• '� .-•�;k—ia �3 .!�7
<br /> r . .y"1 y�s•� _as » a 4.7, »
<br /> 'lawY
<br /> IVI
<br /> ga.+--� » » - » ` `'` .,-`��-., 1..�•,�.��i'�..r+`. ^„�%e Wit:. � �,F.9;c�s�4i,9 `�+'�.ftdy.,A_�9��y'-�i,.
<br /> �� » » �' din' „ a.r ;1 ��:�.�r'a�r-9�J!�� ti4y �,:ar' .�✓ .•s �/
<br /> �3 '�_.___. r .� �� » y--�,�))t..�oo���.., �, ,slly� ;_•
<br /> C as f y �,L,ia'W /�:•k`w0^ .r-^��i�-G3� 5r� ,�+J” �.sl.-Ssr'J t"K r--��i,,
<br /> ' .fIl y9} fa u-_��_ .+?..-:'i» F '1•'�. fi7.g ::}� °-:l�.S"'.ri~ : ', t•F`• i ,•/3
<br /> F9.1 c.y » l' s by r"�1.ie iia. ii)rte' 1
<br /> ��•%w��.l��'j as » ��.>s„•;'"� ii f�i F�'rr �`•.~�' �.^�.s��^•rid=% t.C�.����.,«;:
<br /> -.�� as »�y�y�-"1:+1'""" —�� '�' � � �.�'''-=•:f r;
<br /> r. ~�•^ f> of as { ,
<br /> ._�.—._�_of » •___ _..- of � 7 7 -1 � �.
<br /> r -�•-» of_` �-fa
<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 S1aR",,,000BLE.WELDED, LBS.PER FOOT OR SEATING BELOW
<br /> FT, INCHES OTHER GAGE OF CASING GROUND SURFACE,FT.
<br /> Type and size of shoe or well rAN -_Welded joints—nS joints- Yes [] No
<br /> 1
<br /> D.W.R.FORM No.246 REGIONIAL WATER POLLUTION CONTROL BOARD COPY 28971 Ma 40H DOTH$PC
<br /> 1 c^ r-.4 I c- i -z A/ n '.0 I/r—
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