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OR161NAL LO-ATION 10W UMLLoMr- J <br /> ,ERS bQr <br /> File Qripinal,Duplicate and TriplicateW.A,TER. WELL DRXLIREPORT Do Not Fill Ix <br /> Triplicate with the <br /> DIVISIOY OF WATER 15SC. ER RESOURCES (s«taona 7076,rorT,7o7g,'Ivu�e Code) (�� <br /> R,O 60n Yo7o 1 STATE O CALI FORM IA—DBPARTM ENT OR PUBLIC WORK15 �Statc Well N0. <br /> BACRAMHNTO S CAUI.RPSIA / DIVISION OF WATER RESOURCES Other We11 No. `Region—DRILLER- (person, firm, rr corporation (8) LOCATIO OF WELL• <br /> Name Cennry t <br /> Address R FV or street N <br /> 61, <br /> OWNER. <br /> Name ej <br /> �� fJ <br /> Address (9) WELL LOG- <br /> Total daigh of well <br /> ERIC.'T1� 31 1G?4 . (COSTS )Zp Formatio ltfention rut f water gravel— <br /> Equipment(2) Proposed Use (Check) ftr f; <br /> Domestic Industrial ❑ Rotary ❑ •to d <br /> Irrlgatfon ❑ Test Well ❑ Cable 7�'" <br /> Dug Well --sy <br /> Municipal ❑ Other ❑ Other ❑ � <br /> (3) �A G: i <br /> r ' <br />' fc of an /ga cesing 1 left 'n wdl L <br /> Typo and am of shoe or well nng <br /> ' `• CL <br /> (4) PERFORATIONS* � <br /> I <br /> rpe of perforator tared .' _ cc C <br /> Perforated it to _it holes per <br /> =, <br /> _Diameter of perforations fleagth ,n �• 1 '_�" <br /> i <br /> (5) WATER LEVELS: <br /> War electric log made of well? ❑ Yea ( No If yes attach copy t, • L <br /> Depth at which water was first found •.r <br /> t3- <br /> sr.ndtng lend before perforating fc ..�'G' <br /> `• Y v <br /> Standing level after perforating �} ft <br /> Note your ahnr.avon of any change in water Erre]]!while drilling -(.Q <br /> Was a surface s,m,,ry nal ptoaaded? <br /> (6) WELL PUMPING TEST: Work surged completed <br /> Capacity gal/ours ft draw down �- <br /> Dateaf Repa,&17 <br /> Y91r ' <br /> Was wellrare[ WELL DRILLER'S STATEMENT <br /> g Packed? This—11 was drilled'fuller-ytsrisdfction and this report a true to the bei <br /> re any strata sealed <br /> "iagaaatrt pollution? r aJ ' _.L41K�a^ of my knowledge and belief /! <br /> r <br /> remperarure War a Chemical analysis made? AfJ.ropy <br /> 74ED] <br /> If abandoned war well Capped? <br /> pped? 11"'11 Driller <br /> (7) TYPE OF WORK (check)• By _ <br /> License No Claast6Catr0n <br /> New well [� Reconditioning of well C] <br /> Dated 19—.. <br /> Deepening existing well ❑ 493'0'31 3011 QUlit Q aro <br />