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LOCATION N --- <br /> ORIGINAL STATE OFCALIFORNIA SHEETf-39-723 <br /> Fie Original,Ouplicafe and Iriplkale with the DEPARTMENT OF PUBLIC WORKS <br /> Ou Of WATER RESOURCESF.0.sox 109 DIVISION OF WATER RESOURCES <br /> P.o. <br /> SACRAMENTO S,CALIFORNIA <br /> Do Not <br /> ot fill_I_n <br /> State Well No.— <br /> WATER <br /> _yXER WELL ERS .REPORT QtherWelll Noj_AL^`�. <br /> (Sections 7076,7 7'gOff9:�hh.code) <br /> Region_ell .0 <br /> " <br /> (1) Driller: ' p�I (�P Proposed use or uses(check): (3) Equipment used <br /> Name_,'" `• 4r Damestic ❑ Municipal ❑ (check): <br /> Address.E12s }�`�j� Industrial El Rotary El <br /> 1 �,esti and Test well ❑' Cable ' <br /> AV <br /> License No, __ r _Classification:_ � l i �'!onDu well- `� �g ❑ g ❑ <br /> Other _______ _ __ Other_._.._ <br /> Ak <br /> _-►_ <br /> • Owner:, <br /> Name ` � '' - � _ _, (4 Type of work (check): - <br /> Address _� )°=t` 1""' l-tS - �;%.�?'sl�r�.� New well Pj Reconditioning of well ❑ <br /> Deepening existing well ❑ <br /> (5) Well log: y� ' � !/ �f"' ♦ s� ¢�` <br /> Total depth of well--af.!—ft. Give detai of formations penetrated,such a silt,peat,muck,sand,gravel,clay,shale,sand- <br /> stone,hardpan,rack.Include size of gravel-(diameter) and sand (fine,medium,coarse),color <br /> Depth From Ground Surface of material,structure (Ioose,packed,cemented,soft,hard,brittle). <br /> to <br /> Y.i y— q���a iA1�.•.r �.n r•..• 'Y�:r: <br /> --"'-'—» .o71 <br /> ma>a �.!• j a+' a' .•t% �Yl6f Oa..c` y�'•T <br /> ems-- / ,r•. <br /> ..9 a"` af''`4rr."`t,,,, <br /> y�'J�.Ya' ��» »~� y r'a! ..�o>`'Y�y1 } ri`✓....d!•�, .t�.4.''.`��+�r�V:wur f�..i t;S'ir_i, <br /> 42 <br /> IQY <br /> is IF !a <br /> _ A <br /> as <br /> —_- ^p• <br /> IF as �^ --._-_.as <br /> •—^•_-�_as as�- —�-m J! <br /> » »_-- as <br /> it 91 it <br /> _!~ as as ar . <br /> of^ )A <br /> IF <br /> ....-.-as is IF <br /> » as is1•�J'•7, <br /> as as <br /> it <br /> It <br /> _r )a <br /> IS, <br /> 2f 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 SINGLE DOUBLE,WELDED. LBB.PER FOOT OR SEATING BELOW <br /> FT. NCHES 4 OTHER GAGS OF CASING GROUND SURFACE,FT. <br /> Type and size of shoe or well ring*. j'Welded joint Yes [] No <br /> D.W.R.FORM N?.246 REGIONAL WATER POLLUTION CONTROL BOARD COPY 232713-30 40H OUIN SPO <br />