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rill V1Ip111e1, UePhtele and TrIPlltdle Wllll the (,Sections 7076, 1077, 7016, Weser code) �� 39892 <br /> REGIONAL WATER POLLUTION - - • <br /> CONTROL BOARD No STATE OF CALIFORNIA /////' <br /> r State Well No.,......._.._......._...___.-......... <br /> ^nine appropriate Member) �l"i G( Othre Well No..L: .�..-.::::.tl._�- '> <br /> III ) OWNER : ( 11 ) WELL LOG : <br /> Name 13vron peters Tor[ ditch 200 _ ft. Devth of eomleted well 200 It <br /> Address Rota 1 Bo)I, 1005 Pormedoos Describe by color, rhnartn, size of meenbi, and structure. <br /> I.IatllroD $ a13. .t e _n rt, to -i it 302F <br /> 5 39 •' Clay <br /> ( 2 ) LOCATION OF WELL: � � is Scind <br /> �nnrSan Joa uin oMar'ro.mbr, lren7 1in 50 On rt r1 %7 <br /> R. P. D. or Strict No. t . l Q.j, 0 , atnro� 5n 56 I'I ] 11P sand <br /> ri � Ps n , 5b in d I Blue 0, 71 ajr <br /> T.4, 3 R6Z AoRS rP ] lnur C ] ;IV <br /> 1. . 26 " go I Goarsp sand <br /> go Q51 r ] ay <br /> ( 3 ) TYPE OF WORK ( check) : 05 5and I rayindir�day <br /> New well 0 1 Deepening ❑ Reconditioning ❑ Abandon ❑ �9i •• 1.f1g , tI ^ rA n ^ n <br /> if rbandonmant, describe naterfa{ and �8 •• 11 r a d <br /> procedure in lien ll. } 2 � j1 (+ ] ay tQ I.`. mVm ,mqd <br /> rian <br /> (4) PROPOSED USE ( check') : ( S ) EQUIPMENT• Of170 4a � R mr <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ 1-n IQ() re lg1r <br /> do <br /> Irrigation (� Test Well E] Other E] Cable <br /> 0 1 tea 200 41r a 0 hrnl rn 1 <br /> ( 6 ) CASING INSTALLED : If gravel packed <br /> SINGLE Pq DOUBLE ❑ Gage „ <br /> Diameter fromto <br /> From (,, to ft. Diem. Wall of Dare it. ft. <br /> 18r <br /> Type and size of shoe or well dnaIII •.• If <br /> M Size of gravel: <br /> Daodbe )oinc T`ie_ . h .. It .. <br /> IV <br /> (7 ) PERFORATIONS: „ <br /> TTw of pertaeeae ad <br /> size of ri gala s 3 / 16 in., length, by 3 le. 40 <br /> From D, rt. Part. per r naw per n. ., ., <br /> m ow <br /> I I 10 44 44 11 <br /> I do <br /> .. ] k •• 170 ., ., ,. . , .. .. .. <br /> gig <br /> 44 it <br /> oil <br /> (g ) CONSTRUCTION: ,,.. ,} <br /> Wsi a earfea unitary sal provided? O Ya No To what deeeh 4. ,. .. <br /> Were car 'areas sided etefae "notion? El Tat I$No If 1m, note depth of man .. to <br /> From ft. to ft. of I <br /> if <br /> of to <br /> Method of Sealing Won nernd 4 A to 7 s comtlma 4 t 10 57 P <br /> (9 ) WATER LEVELS : WELL DRILLER'S STATEMENT: <br /> h. This will was drilled under my jurird)ction and this report is true to the best o. <br /> Depth a which wan war Dae tonna <br /> 27 my knowledge and belie/. <br /> a.,oamt lend h.faup«fand°t r0' NAME Clark Well Drilling Co . <br /> dine level after elaborating it. (Pcaon, firm, or earp4r;t r iTyped or printed) <br /> Address 20211 Be Charter laV <br /> ( 10 ) WELL TESTS : S cicton 6 Calif . <br /> Va a pmnt as medal {4] Yaw ❑ No If Tae, by whemt P . G . E • J) <br /> Yield , / 05 .gel./min. with. Q , 9 ft, draw dons etkr lits. �7 Well Drilled, p / r7 <br /> Tmaid raeae of water Wae a ehemial analytic areas? ❑ Ya M No License Not.... 2 ..: Dated.........C.l.10I5.1 19 ~ <br /> Tat electric lot made of wall ? ❑ Yes pp No 25469 344 SON ae,R sro DWR FORM NO. 246 ( REV. e4eb <br />