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—ORIGINAL <br /> File Oripinal,Dnilcale and Mpllcale with the SrIEET 2 <br /> DIV 310k c.,n 'tea RESOORCS <br /> 1 0 Box 1079 <br /> 13ACRAMENTO g CALIFORNIA <br /> WATER WELL DRILLERS REPORT Do Not FxF In r� <br /> . (Sections 7076,7077,7078,Wnter Code) State Well No 4,144.17RI <br /> Other Well No __ <br /> Region---- -------- <br /> '�------- <br /> (7) Perforations <br /> Type of perforator used- ----- -® �!! ___-- _-- _-- P. -- - <br /> Perforated__— ----_-___—ft to----�D _--__--fit Hole size_—-- ---------_-_--No of holes__.--------------- <br /> .1 <br /> --___..„ <br /> ,. ,r <br /> (0) Water levels: F <br /> (9) Well gimping test: <br /> Depth at wluch water / Date of test2_—,e_2-_`E'By <br /> first encountered__—____— .____ft Depth to water when test started —_____-_ <br /> Depth to water G P.M at beginning of <br /> before perforating_ —_—__ ft Drawdown from standing <br /> Depth to water G P M at completion of <br /> after perforating_-- —___—_—£t Drawdown at completion of test—_—_—_----____ __—__ft <br /> Note any change in water level whsle dulling Length of tune tested <br /> r ---- _ Temperature of water--- <br /> 'Was <br /> ater_—Was gas present in water? ❑ Yes / o ----- <br /> (10) General _ <br /> Was well gravel packed)— —___--Size of rock__-___— —________T1uckness of pack <br /> Was a surface saritary seal provided>.__� ____ �_ _--___ I_ 't'. <br /> Were any strata sealed auist uti ? e No If yes, attach detailed 4escriptlon <br /> Strata sealed r _�_� - <br /> Was analysis made of water> ❑ Yes If yes, attach copy <br /> Was electric log made of well) E] Yes �o If yes, attach copy- <br /> If well abandoned, was is plugged and <br /> Method of plugging and sealing _—_--- -------__------------------- <br /> (I 1) Loca r e” (12) Tune of work <br /> rt Section No_ _/__________ Work started date____—_________Completed date __ <br /> Township___ __ Date of this report <br /> Range-----7— — <br /> Base&Meridian A/—_ __ WELL DRILLER'S STATEMENT <br /> Show location of well in Sec- This well was drilled under my jurisdiction and this <br /> xion,thus (X) report is true to the best of my knowledge and belief <br /> Distances to section lines from <br /> well, or S__3_0gg___—ft [SIGNED]--- <br /> and <br /> SIGNED]___and L: .'A <br /> Show loca yyat -Iaearestrr _{,r•^r,�lri�, By_ ---------- -------------- <br /> known <br /> --known well, thus (0) License No �•3IassificatioR . <br /> I MILE Distance to nearest/"Pwn <br /> �r ys =• <br /> ft Dated - ' <br /> D W R FORM No 246 REGIONAL WATER POLLU'T'ION CONTROL BOARD COPY 23972 3 30 40M QUIN sPo <br />