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r <br /> LOCATION NOT CHECKS <br /> ` ORIGINAL WATER WELL DRMLERS REPORT bo Not <br /> Fiat tn. <br /> File Odginal,Duplicate and Triplicate with the (seetiods 7076,7077,707t;Water Code) Q 318 4 0 <br /> REGIONAL W.&TER POLLU'T'ION <br /> No <br /> COSTATE OF CALIFORNIA / �� StaceWeiiNo, <br /> CONTROL BOARD - <br /> russet approprlalesomber) OtherWO1IN0»a? _ <br /> (11) WELL LOG: <br /> ame �j.Ji% ,"�ia� r / TatsE depth ft.' Depth of completed welly( f <br /> Address Formations Describe by eolor,rbararter,tlu of maletfal,and structure. <br /> fe. <br /> 41^7 ro • , !D°�sJ^r9A; 3 ( s4 r -l»f�!%r�L.J t <br /> (z) OC4 OSP?WELL: 'Ovwrlpf•9,r a <br /> `1 q > • a y!J" wna's numb".if any— <br /> or St No. tr <br /> '} t t e.�.'� '] t/ .Yy 'J. �, / lhv Aix ° OJ•• �i• t.�i•}A••a � .D <br /> tt .ll.l,:q:! +I! J } .J°•} �.! J'I g t r rte. ,(� a ���� q y <br /> �^ .. «$ ..,c'f �' O�'1s6A:: '1:rtJ'KJ�49 rr <br /> aa- <br /> Ail <br /> p +a.a <br /> t da., .. / a7. 9aaci�� ' g�t'•;s .n;�. J�: fR <br /> J '' ,I -•C 't 4�-e1 ry� 4�71 ��'r 4.s:1::':i-.KTx,�r�i..t'Rv�''}'r'$•.� <br /> (3) TYPE OF WORK (check): ' <br /> New well ij Deepening Reconditioning Abandon Q n ; <br /> 1 f abarsdontaeut,describe material and proeedsfre bl Item Mr <br /> (4) PROPOSED USE (check): (3) EQUIPMENT: <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ J <br /> � <br /> Irrigation TestWell ❑ CableOther ❑ Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE❑ DOUBLE❑ Gaga ` <br /> or Diameter from to '•C? "T <br /> From It.to Jr. Dram. Wilt of Bora It, it. <br /> '•d <br /> Trpa and a(u of she5 t w II r[ °� a ., 1 Site of grarelsa p ,i .. « <br /> Describe Joint i. •.>s a" :l•_.)r. rel 3 0' "��^fi tJwii;i » <br /> PERFORAT ® 1- Z 0' —; <br /> Type of perforator wed �• <br /> Size of perfoettroet in.,length,by <br /> From ft.in ft. Pari.per row Rows per it. » » <br /> Fm <br /> (S) CONSTRUCTION: r� ver(-rn?nt USE M <br /> Wo x surface ranitarT Sell Provided? _0 Tea (]No To whee depth ft. „ „ <br /> veto any$testa"idea against pollution? 13 Yes ❑No U yet,note depth of strata .. r. <br /> From ft.to <br /> Method of Sealing )1+a: r�.%�:�r Work stated 19 Completed ` /')..til°s E� I9 ti <br /> (9) WATER LEVELS: WELT,DRILLER'S STATEMENTI <br /> Thir well was drilled in der my jurisdiction and this report it true to the best o <br /> Depth at which water war fust founds p f my knois ledge and belief. <br /> tending level before perforating It. NAME <br /> Ism level after perforating it. (Person,Bran.or corperetiom) (Typed or prlaledl <br /> Addrms <br /> (10) WELL TESTS: <br /> Vega pump tett made? A Yea ❑No If yaa,by-haat 4`� •T •bp ;,�� <br /> [$ICNF.4} «7 .n .s..7.f+I...!. �.._e•r. rt ,F '+at.i <br /> linitis ti sI "» gal/min,model <br /> It.draw down after hes. 71 <br /> Well Dr1Rer <br /> Temperature of water Wan a ehemlol analysis trade? 0 YeS Q o +J S License No � �� Dated _._ 5 29—_.._ <br /> Vu electric log mads of well? 0Yet 0 Na <br /> 96662 8-5e SOM QU&N M SPO OWR FORM No.246(RLN.3-S4; <br />