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• n r, <br /> Ll'} r1vi:Do1�ot���,�'ti�� <br /> ORIGINAL WATER WELL DRILLERS REPORT <br /> File Original,Duplicate and Triplicate with the ee N0 48888 <br /> (Swens 7076,7077,707[,Nater Cede) � <br /> REGIONAL WATER POLLUTION <br /> �_ STATE OF CALIFORNIA S j well No _ - - <br /> CONTROL BOARD No ` <br /> rf opproprfafe womb") Other Well No. .r — �a <br /> (1) OWNER (11) WELL LOG <br /> Name _ Milton Johnson Total depth go ft Depth of completed well ft <br /> Address DQ. Box Formanon Desrrrbr b>ro'at chot.rler rose of anerertal and s/raclare <br /> ft to Z ft Top Soil <br /> 3 15 Clay <br /> (2) LOCATION OF WELL. 1 .5 <br /> 17 -`+ , <br /> county San T G a 7.. Owner t number tf aov— 17 `3 C C 1&y" <br /> R F D or Street Na <br /> t` rt F <br /> S nd <br /> GB Cla <br /> Gravel <br /> I <br /> (3) TYPE OF WORK (check): <br /> New well %] Deepening 0 Reconditionang © Abandon 0 <br /> if abandonment,describe maternal and procedure in!fern 11 <br /> (4) PROPOSED USE (Check) (5) EQUIPMENT- <br /> Domestic ❑ Industrial ® Murucipal ❑ Rotary ❑ <br /> Irngation ❑ Test Well ❑ Other ❑ Cable <br /> Pq <br /> Dug Well ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE[7,DOUBLE 7 Gage <br /> or Diameter from to <br /> From it to it Dtam Wall of Bare ft ft <br /> r p r l <br /> 7I pe and sore of shoe or well ring �- A ., tl Stze of gravel <br /> Describe Iornt <br /> (7) PERFORATIONS: <br /> Type of perforator wed <br /> Size of perforations set <br /> Frortri ft to ft perf per row Ross per ft <br /> 58 76 <br /> -- <br /> (9) CONSTRUCTION. <br /> Was a surface sanitary seal provided? ❑ Yet ❑ No To what depth ft <br /> ?Vere any strata sealed against pollution? ❑ Yet 0 No If yea note depth of strata � �� — -�� '_ _ 5e E,'n: % a <br /> From ft to <br /> Method of Sealing Work started rf—25_5i79 — completed 7-26—.r)7 19 <br /> (9) WATER LEVELS. WELL DRILLER'S STATEMENT <br /> �J This well was drilled w7der�my jurisdiction and this report is true to the best of <br /> Depth at which water was first found 4 f ft my knowledge and beluf <br /> dreg level before psrforoteag ft NAME <br /> ding level after perforating ft fl'e rson firm II IArd nr rrr,rrrd) <br /> Address Rt- 7 TIC}x 1 5 PQ <br /> (10) WELL TESTS- <br /> Was a pump test made? ❑ Yea [] No ?f yea by whom? 4 <br /> i <br /> [SIGNED] - - '- <br /> Yseldr gal/min with ft draw down after bra p r�r�w {rel?DrfNrr <br /> a l 2 <br /> Temperature of water Was a chemtcd analysis made? ❑ Yes ❑ No License No 5 Dated s 19 <br /> Wa=electric log made of well? 0 Yes ❑ No assns a sa sone aueN 0 wo DWR FORM NO 246 trtiwV 3 647 <br />