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F11e0r1g1n41,0ap11ca1eeadjopllcalewllh1ha �� L'V"'i <br /> DIVISION of 1 14(' kHOURtos TT2 <br /> PHOXr1079 • ..z <br /> ' SACRAMENTO S.CALIFORNIA 1 Fy.j'+�=�� f% .` i r <br /> f <br /> WATER WELL DRILLERS REPORT Do Not.Fill In <br /> T r� <br /> {secctohe 7076,y1077,7o7s,Wrtter Coda} State Well No____.._. <br /> Other Well <br /> (7) Perforations-, <br /> Type of perforator used . ,__ __ ___ ___ •_. _ _ <br /> Perforated._.-,-_..._..�___ ,-'R-ft. ta_-�7-A T_M#t. Hole of <br /> ' }, �.._.....�_._.._..��•-'-•a, ,.!_.._.�______.�..1..,..._..,a as ,> �_-,..___-_---__._ � .__,_ '�"__._._._..� <br /> ar a >f <br /> 1 fa ._.v....�•_.�ti•��i.-�......-.,a 1}-._.. _.�...�+.- ,�._.._�T fa fi a' w..-..��• _— «-_—..ter. >a ff ,i _.........ter-....-..--.«�.„r <br /> !, to <br /> ' (8) Water levels: (q) Well pumping test: <br /> Depth at which water Date of test— <br /> first <br /> est_first encountered__-_w_._____._, -_ __ _f t. Depth to water-when test started <br /> 't Depth to water -�- GNX. at beginning of test..-�---e---,.T__ <br /> before perforating__ _____..__-_ _ft. Drawdown from standing <br /> Depth to water G.P.M. at completion of test---- <br /> after <br /> est_.- -;after perforating_ __. _ v ___ft. Drawdown at completion of <br /> Note any change in water level while drilling Length of time tested _- __�_ ___: -.__ _ ------------ <br /> -: r' --.._-.-.___.-._.__.-.._-._.--_..-.___ -.....-.,. ------------- Temperature of a=a ter__._.__ _-__--------•-------•..--------- <br /> Was gas present in water? ❑Yes ❑No <br /> ' (10) General: <br /> Was well gravel of rock--.----.-_.,-..-._-_.____._,--Thickness of <br /> Was a surface sanitary seal provided?_ ..-_- _ . 1 <br /> Were any strata sealed against pollution? C1 Yes No If yes,attach detailed description, <br /> Strata <br /> ' Was analysis made of water? ❑ Yes ❑ No If yes, attach copy. <br /> Was electric log made of well? ❑ Yes ❑ No If yes,attach copy. , <br /> If well abandoned,was it plugged and <br /> i� <br /> Method of plugging and <br /> ' (11) Location: ��h;u.3 Neu n•�> r7�� f✓ (12) Time of work; <br /> Nnrtb Section No.-_-._Y-_._..-___.. Work started data-73_-g7 1-Completed date:L2-27 51 <br /> ' Township—_-___- Date of this <br /> Base&Meridian.-_.._._ WELL DRTLI-EwS ST'A`Y;mmn <br /> Show location of well in Sec- This •toed was drilled under ray jurisdiction and this <br /> tion,thus (X) report is trate to the Best of my knowledge and Belief, <br /> Distances to section lines from <br /> well, N or <br /> and 1~or W._. ._^_._R,ft. m.rr n,rrilt <br /> Show location of nearest D �-«-✓tel .....__..T, <br /> known well, thus (0) License No._�?� __..Classiflcation � <br /> I MILE Distance to nearest known <br /> Dated.... ........ _ _ .., ., 19. <br /> � r <br /> I <br /> ' REGIONAL WATER POLLUTION CONTROL BOARD COPY <br /> 2]471].Yd aDNiy:UfFil <br />