Laserfiche WebLink
DUPLICATE WATER WELL DRILLE) S REPORT Do Not Fill In <br /> �T <br /> File QripIna I,Duplicate and Trfplleale with the (Secttans 107c,7077,7071,water cede) 1r 0 55 311 <br /> REGIONAL WATER POLLUTION 1 <br /> STATE OF CALIFORNIASrueWell No (tom <br /> CONTROL BOARD No <br /> 1f?ti( �- <br /> • '.are approprfale cumber) � 6 Ocher Well NoQ t Wo (aE- Q S <br /> t l) OWNER. (f 1) WELL LOG. <br /> Name �� (Zr �6L j Total depth sl it Depth of eompkttd well /�`O <br /> r�ddCCSS /4 ?� �- /��i�� hf�� Fvrrnectaa Drrrcfbr by valor,ebarorrer,size of alAltrlat gai llfkrrbrr ^ <br /> L -�� fc to it <br /> (2) LO ATION OF WELL 31 <br /> County ' Owotr s number ,f eny— t f `3, - [•.dE <br /> R F -7.1 strtyrg, <br /> to <br /> p 5 <br /> ro <br /> (3) TYPE OF WORK (check) f� <br /> New well 1�1( Deepening ❑ Rccondiuoning ❑ Abandon ❑ .d 2 <br /> It obandonrreeret,drscrebe rnaterrol and procedure in flem 11 ifs <br /> (4) PROPOSED USE (check.) (5) EQUIPMENT- <br /> Domestic :R- Industrial ❑ Munlctpal ❑ Rotary <br /> Irrigation [❑ Test Well ❑ Other ❑ Cable <br /> Dug Well ❑ <br /> (b) CASING INSTALLED If gravel packed <br /> SINGLE Ig DOUBLE,-_ Gaze <br /> oDiameter from to <br /> From it to it Desm V.J] of ear. It it <br /> Type and size o1 shoe or met]nn1 IgoSue of 1nvel <br /> Describe pint <br /> (7) PERFORATIONS: <br /> Type of perforator used <br /> of perfarat,oar sa.,length,by _In UAL USE ON <br /> I _ <br /> From it to ft perf par row lto%s per it <br /> (8) CONSTRUCTION: <br /> Was•surfan mastery seal provided? Q Yee ❑ No Ta vlut depth ft ` <br /> Were any errata Maw*$atnat pollution? Ya ❑ No If ya,note depth of strep <br /> From ft to it __•'• <br /> Method of Seal,ng � _ _ _ Wert stared <br /> ... ��..�....�.�.�....�..�.,.���........... �.�� ,..,, � �•Ff ._19 � Completed <br /> (9) WATER LEVELS: WELL DKII.LER'S STATEMENT <br /> Tbr1 well was drillfd undaf my larrfdrrfMand ibis i'r u twee V9' i61 of <br /> Depth a:which inter woo fins found ft my kaowkdge and b f � port 1 <br /> ] s <br /> •ndsns level before perforst ng�. �. ft _ <br /> NAME ,�-t,,E.,rl►t__ 6Z.1 � <br /> .est l after perfo <br /> k ratcuF ft (Perron firm or curpc,atron) f rY6rd nr Neared) <br /> ' �-- Address <br /> 1f?) WELL TESTS: <br /> t 4nrnP test made? ❑Yd Q No If Ta,by wham? t <br /> L <br /> ` SO/nun with it draw down after hro [$iGHEO]T <br /> bort of water __. __ Was a chemtcsl analysts spade? ❑ Yn •❑ Ne License No_ __ __ Dattd- _ <br /> r--Ic los made of well? 0 Tel ❑ No <br /> - a�afe a sy e u n <br />