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L C?,T1CNDM K <br /> ORIGINAL' `WATER WELL DRILLERS REPOKT ° t F� <br /> Fite Original,Duplicate and Triplicate with the M 48888 <br /> (Sections 7076,7077,7071,Wuoe Coda) <br /> REGIONAL WATER POLLUTION <br /> State Well No.—___. <br /> CONTROL BOARD No . _ <br /> __5_— STATE OF CALIFORNIA ut-w� +! �'-/`T'-': _h r•� <br /> (losers appropriate number) Other Well No.A=�• *M� <br /> C <br /> (1) OWNER: (11) WELL LOG: <br /> Name Milton Johnson Total depth sn fr. Depth of completed well 80 f <br /> Address D 1. . Rn-r For-6— D,smbr by co;or,ch—ter,size of anterial,assd arvcstare. <br /> 0 ft.to :? f:. Top Soil <br /> 1 15 Clap <br /> (2) LOCATION OF WELL: 3 5 17 Sand'7 <br /> County c. ti oaquin Owner's number,if any— -1 f 30 Cl a,7 <br /> R.F.D.or street No. 3n ,�P Crave <br /> ?>y_ corr,_ar of N 7�y_ 3 of z2 54 Clay <br /> �- 54 56 Sand <br /> Sec . 2.7 - T. 2 Sao D 5 F - 56 " 68 Clay <br /> 6F3 R9 Sand & Gravel <br /> (3) TYPE OF WORK (check): <br /> New well $i Deepening ❑ Reconditioning ❑ Abandon ❑ " <br /> If abandonment,describe material and procedure in Iters 11. <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: " <br /> Domestic ❑ Industrial ® Municipal ❑ Rotary ❑ <br /> 99 <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE DC DOUBLE^rl Gage .. ., <br /> Diameter from to <br /> or <br /> From it.to it. Diam. Will of Bore ft. it. „ <br /> Trpe and sae of shoe or ,it ring X l X1 If Size of;ravel: .. ,. <br /> Describe joint <br /> (7) PERFORATIONS: <br /> Type of perforator used ltildeniYi2 • <br /> S1Ze of perforations 1—8 X 1 in.,length,by in. <br /> From ft.m ft. Perf.per row Rows per ft. <br /> 68 76 <br /> (8) CONSTRUCTION: <br /> 'pas a surface sanitary seal provided? ❑ Yes ❑ No To what depth £t. <br /> J Y• _ _ <br /> Vere any strata se"against pollution? ❑ Yes ❑ No If yet,note depth of strata <br /> From ft.to <br /> --- -- -i <br /> Method of Sealing York starred 7-25-579 Completed <br /> t <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> �y This well was drilled under my jurisdiction and this report is true to the best n <br /> Depth at which water was first found GQ ft• my knowledge and belief. <br /> —aadins level before perforating : ft. 'VA'41En"L <br /> �. raZ2.'riZTs CY' ("137"7'01 I <br /> :nding laud afar perforating - - ft. (Person,5rm,o:corperanon; fTyped or pnssrd; <br /> Address t. 7 ;o x 7 Fi7(^i <br /> (10) WELL TESTS: <br /> Mo a.---.- . <br /> Va.a pump use made? ❑ Yes ❑ No If yea,by whom? •/Arm/ ''L_ <br /> Yield: ,tat.;min, with it.draw down afar hes• [SIGNED].;±^Ie==•--=-••.—__. 11 Drill" — ._... <br /> Wd!Drill" <br /> Temperature <br /> - <br /> Temperacute of water Was a chemicsi analysis madet __ Yea ;Z No .. ...� <br /> License No.--•-----�.1.��-----............ <br /> Dated-..........................------------__, 19---- -- <br />