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rwl <br /> .. <br /> L1 ,�!C <br /> Do E <br /> ORIGINAL, ` , WATER WELL <br /> ��gr yg �t� REPORT'fO".,t 0 rt Not Fill Inf CIN: i <br /> rite Original,Duplicate and Triplicate with the (Seetiosts 7079,7077,7479.Water Code) ? 9741 ' <br /> REGIONAL WATER POLLUTION Stoma: Well No. {-$ -__9'.'I e_ <br /> CONTROL BOARD No STATE OF CALIFORNIA <br /> (rortrt approprlals nnutbrr) Other Well I1o•a C /' -�z. <br /> OW�FR '� -1! r:; (I1) WELL.LOG: 3 8;E -� <br /> Name 7 1 f.a. rf .1 V +.'i ct i, I •' Total depth fr. Depth of eompleted well rl !�� it <br /> Address a! f �' a_•t j` !V— <br /> D Formations Drrrribe by color,rbgarlrr,tiv o/=91971st,god rlrualurs. <br /> fr.to <br /> f.•' 't :ri ,1,7� i 1 a " I,i h' �1J ,1 lir"•� l�t.� { �•/.r. 7 /': <br /> (Z) L©CAT.ION OF WELL: 4 r' i ,: r�'r{%1� •' 1/' a t •)yr ,�' <br /> Coanty� .�,4� ,• :} t• � Owaat's anmI�r,if any r• t / • <br /> r .•r ,• t <br /> D.orSr e t r. } ?,l r R r 'T t I �7 f, r f: ice.•}?r.7�t. 7 t l r 7/:( r 1j 7 l r} <br /> RF. uec�Irjo. t i• . ,� t :• "f .� t. •f .i�• i ,'`� ••1� <br /> J a ,7 :� r).t,t.F.+ `� s1j` ti'I r� ..riUcr* rj t.r .� ! fes) •� tt r !• <br /> '(3) TYPE OF•WORK (check)t " » <br /> New welt Deepening ❑ Reconditioning ❑ Abandon ❑ " <br /> it abandonment,describe material and procedure hs7tetar f i. " <br /> (4) PROPOSED USE (check): (5) ]EQUIPMENT; " <br /> Domestic ❑ Industrial ❑ Municipal ❑ Roca , <br /> Irrigation Test Well E] other ® CAUry <br /> Du Well ❑ <br /> (G) CASING INSTALLED: If gravel packed <br /> SINGLE[i DOUBLE I`�]' Gage �y <br /> or Diaalcter from to <br /> From it.to ft. Dram. Well of Bora fa it. » <br /> 1109 lc` <br /> " .. .. <br /> » <br /> Type and size of shoe for wcl�rinjl�:;J�' Sae of smelt » „ <br /> Describe joint il�riji •r:•(t r 4 » » <br /> (7) PERFORATIONS t .. <br /> Type of p1dotatoe rued ., <br /> Size ofyerferations in«length,by Lt. <br /> i <br /> From ft.to ft. pert.per raw Rows per it. .. .. <br /> (s) CONSTRUCTION: <br /> Wq s aerfaea saaipry tail pto�Ided? ❑Yev ON* To-what depth ft. ,• „ <br /> Wets any strata scaled against pollution? ❑Yet ❑No 7f Ter,note depth of septa <br /> From ft.to ft. . <br /> Method:of Sealing ('D:-. t,1,% t—=--�--- Work started 19 Completed i9 - <br /> .� one• <br /> (9) WATER LEVELS: > WSLL DRII.LER'S STATEMENT: <br /> This well was drilled under my firbdjellon and ibis report fs trtte to the best of <br /> Depot It which ware wet 5m found my knowkdg�erwd belld. <br /> Spading larel before peforetiag fs. NAME <br /> Ask'Ll.,teasl afro pedotedag ft. /'a•�-s.JF*rst6j6rm.or <br /> pt ar(nd d( (7,04 <br /> p4 or pr9nladj <br /> Address t <br /> (z o) WELL TESTS: w i ��. >r e on �r l <br /> Was it pomp teat made? ❑Yet 0 No U yea,by whew? rK <br /> ' <br /> Yklda gal./min with Et.draw down after hra. (STONED) <br /> / . «•��/� matt Dtlrtrr <br /> Temperature of water Wu a chemical aailysis model ❑Ya ❑No License NO . Dated. <br /> Wu electric log made of well? O Yee ❑No 33at3 3.56 ataM OWN S SPO D WR FORM No.246(Hitt/.9-54) <br />