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� � ""t � x � � r r��4 i S•�� i H <br /> 'Water Filljjn,- <br /> @ , , <br /> ORIGINAL WATER WELL DRILLERS REPORT NO Do Not s�i�i�� rFile Original,Ouplicale and Triplicate with 1he (Sections 7076,7077,7073 ater Code) <br /> REGIONAL WA'T'ER POLLU'T'ION � � State Well No <br /> CONTROL BOARD No STATE OF CALIFORNIA � � r <br /> •tort approprl.Er..ember) {� Other Well No. _ <br />�S <br /> �) OWNER: (11) WELL LOG. yy <br /> Name -1 / r Total depth/6 (/ it Depth of completed well 1 V IT <br /> Address 1, Formation Dti—be by color,ebarprtor,erre of nsaterral avid rerurtare <br />' it to It <br /> (2) LOCATION OF WELL- <br /> Count y Owner s number if any— <br /> R F D or S et N <br /> La <br /> L r, r ^ <br /> C, <br />' (3) TYPE OF WORK (check) <br /> New*ell .k Deepening ❑ Reconditioning ❑ Abandon ❑ <br /> I/abandonment,desersbe material and procedure in hears I1 <br /> (4) PROPOSED USE (check) (5) EQUIPMENT: <br /> ' Domestic ® Industrial ❑ MunicipaI 0 Rotary x <br /> Irrigation ❑ Test Well ❑ Other Cable <br /> El <br /> Dug Well <br /> ' (6) CASING INSTALLED• If gravel packed <br /> SINGLE A DOUBLE Gage <br /> or Diameter Era- to <br /> From ft to it Dssm Wall of Bare ft fc — — <br /> 1 _ <br /> Tvpe and si:t of ehoe or well ring , <br /> site Of Sri we] <br /> ' Describe joint a&24V--r <br /> (7) PERFORATIONS - { <br /> Type of perforate-used <br /> Size of perforations in,length,by m <br /> From ft to ft perf per row Aowe par it <br /> (S) CONSTRUCTION. <br /> ' Was a surface sanitary seal preesded? Q Yea ❑ No To what depth it +� <br /> Vere lay strata sealed.Stunt pollueten? Yet ❑ No If yes,cote depth Of strata <br /> From rt to it <br /> 0 e 14 <br /> Method of Sealing Work started J- 7_ 1941 Completed 7 <br /> (9) WATER LEVELS: /7:2 WELL DRILLER'S STATEMENT <br /> Thn well was drilled under any lurrrdrctjon and this rrport is true to the best of <br /> 0th at which water war first found It my Anowledge and belief <br /> diad level before perforating fe NAME <br /> an la►ei after parfoeatinjj A (rcrson,firm or eorporacl—) I'ybs!or prratel) <br /> Address <br /> (10) WELL TESTS: <br /> _ _ _�!- a <br /> Apar a pump tett made? ❑ Yes ❑ No If yes,by whom? <br /> Yield Ail/syn with ft draw down after het I.SIaN8a1 1V'oU DrfWrr <br /> Temperature of water Wet a ehemicel anai+ass made? 171 Ye. r-I V. <br />