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ORIGINAL WATER WELL DRILLERS REPORT Do Not FII In <br /> File Original,Duplicate and Triplicate with the (sections 7076,7077,7078,Water Code) lr U 56595 <br /> REGIONAL WATER POLLUTION w l� ' <br /> CONTROL BOARD No. <br /> STATE OF CALIFORNIA Sate WellNo._`�,� �-E__-_JL _ <br /> — � rt aQProQrlefr nnmbrr) 7, STATE <br /> G/•� OC}tet Well No-------------------------- <br /> i) OWNER: (11) WELL <br /> LOG: <br /> N-ime Total d< th (�l7C f: l <br /> .r r 'Depth a[<ompietrd well <br /> Address P �� 9/ Formation: Describe by color,rh+r ct—.rite of meterial,end rtruo?ore. <br /> ft. to a. <br /> 2- <br /> (2) <br /> (2) LOCATION OF WEL : 2- <br /> County <br /> County Owner's number,if any— <br /> R.F.D.ar Stree .o. <br /> � .. <br /> Iy <br /> 14.7 ;L <br /> (3) TYPE OF WORK (check): <br /> .Z.3 j <br /> g it <br /> New well Deepening (__1 Reconditioning El Abandon F-1 -'-I- <br /> v <br /> a,e if abandonment,describe material and procedure in Item 11. 331 <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: 'Yf-2- S'D,S_'� _Ce <br /> Domestic ❑ Industrial 'X Municipal ❑ Rotary ❑ 1'a`�' O <br /> �., Irrigation ❑ Test Well ❑ Other ❑ Cable -5:70 ''- <br /> Dug Well 3q0 5- ' <br /> (6) CASING INSTALLED: If gravel packed t—b 2 I <br /> SINGLE E] DOUBLE Gar ✓ "� o _ <br /> og Diameter t:om to <br /> From ft.to ft. Diana. Fall of Bore is. ft. <br /> �r loan <br /> Type and size of.shoe or well r4g l`r)A 9 1Size of gravel: .. <br /> Describe joint _tyT� X Ys, <br /> ;A <br /> (7) PERFORATIONS: <br /> Type of perforator toed ) <br /> size of perforations in.,length,by in. <br /> From h.to ft. Perf.oer row Rcw+ocr ft. 111s Uv} <br /> ' �w o .Ly' <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary seal provided? ❑ Yea ❑ No To what depth ft. <br /> v Were any strata sealed against pollution? Yea ❑ No If yet,..it depth of macs <br /> From rt.to ft. <br /> Method of Sealing L�t� 7s- Work started ,�_ ? 19 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> b ' This well was drilled under my jurisdiction and this report is true to[be best of <br /> Depth at which water was first found O �► ft. my knowledge and belief. ., <br /> --ding level before perforating ft. NAME n) '�, o:; •i s ,r._ <br /> :.� ;moi(,- ...:1 j:. int e-�—"1'`=j. 'r� �• <br /> e'cvcl atrer perforating 4 ft. ,:'.LLn,sirm,or wracuuou, ur iris ete J; <br /> Address <br /> (10) WELL TESTS: <br /> was a pump it made? ❑ Yes ❑ No It yes,by whom? 'tJ_ _ ,, .. <br /> Yield: 1 gal./slain.with it.draw down after hrs. 1SIGNED]----_—._-._.._.-._...--__..1- - --1=! ----- -.tom Gr�i ----- <br /> Writ Drifirr, <br /> Temperature of water WAS a chemical analysis made? ❑ Yes ❑ No <br /> License No---------------•----•......._....------ Dated --------.......-----......... --•--.,19--- -- <br /> Was electric-log made of well? ❑Yea <br /> ❑ No I <br /> 5.1025 6-57 50u QUIN A aro OWR 188 (REV.3.341 <br />