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I <br /> flood- jq <br /> ORIGINAL WATER WELL DRILLERS REI vRT �7 Do Not Fhl In <br /> I, <br /> Ille Original, Duplicate and Triplicate with the (sections royd, 7ar1, 7oy9, Water Code) N ° 56595 <br /> REGIONAL WATER POLLUTION W ' / <br /> C TROL BOARDNo STATE OF CALIFORNIA Stare WellNol <br /> •+ aPprapdum <br /> ase "swab") 7e /"n. IF$ Other Well No.___.,._ <br /> ) OWNER: ( I1 ) WELL LOG: '! <br /> Name ��i n �l �f -notal drnth 6 �D re, Depth of completed well GL4 <br /> R. <br /> Address e 92 , 9/ Formation: Derrr)be by color. cbaraclm, flu at indWal, and r/rwelare, <br /> I ft. to rt. <br /> ( 2 ) LOCATION OF WEL L 2 <br /> Coumy Z. 'YOwners number, if any— � ' "Lor S <br /> A. F. D. or Strce I dJdl T ..e,i xA .�, _ L /l� '� ��', •• " 2D <br /> V As = ti <br /> 23 c <br /> ( 3 ) TYPE OF WORK (check) :I/ 2. .' s k <br /> it ,• � <br /> New well Deepening ❑ Reconditioning ❑ Abandon ❑ Zr r6odde LS <br /> If abandonments describe material and procedure in Plot ll. X310 - X 92 - � <br /> (4) PROPOSED USE ( check) : ( 5 ) EQUIPMENT: JVYIF, If$ v` �j'Sz <br /> Domestic ❑ Industrial Municipal ❑ Rotary ❑ D D 7C <br /> Irrigation ❑ Test Well ElOther ❑ I Cable ✓yid .. �' P 3 <br /> Dug Well y .y, <br /> ( 6 ) CASING INSTALLED : If gravel packedy�// 0 •.p _ <br /> SINGLE EJ DOUBLE Gose 'f J Y t go 0 " Ze <br /> or Diameter from `-afjp <br /> From ft. to ft. Dianne Wad of ]lore it. fr, ~ doodded <br /> 1D <br /> .. � .. Neq 42/Figf.. SiN f � J •. / .1 •• <br /> do <br /> dl <br /> .. it 41 <br /> Type and till of ,hoe or well ri 6/G �Ad X Size of Panels ,• ,• •• <br /> <dl <br /> ., <br /> Describe blot ^f5 )l . <br /> (7 ) PERFORATIONS: <br /> Typo of perfpnro[ med �, it <br /> •• <br /> t Slti'e of perfontlona pert 7 Rth b <br /> ,. <br /> Promooddled— n.•.n DOS at <br /> n. /F .. ,. .. erf to <br /> .. <br /> wraw <br /> ,. .,. ,. <br /> ft A p f <br /> ' <br /> d� '• 33G ' .. .. .. .. .. <br /> •. . 9 <br /> to of <br /> If 4V 11 it IF do to 10 <br /> ( 8 ) CONSTRUCTION : <br /> was a aurfaeo sanitary teal provided? ❑ Yet ❑ No To what depth fit 14 <br /> - <br /> Veraanystratavesmagainstpollution] Yes EI If C / <br /> jl] Yes, npsd depth of .tun <br /> From it, to tt. -- .. <br /> " v oSo <br /> we IF <br /> 1 Method of Sealing Wong startedq p <br /> .!— p 1y / . Completed ly <br /> (9 ) WATER LEVELS: WELL DRR.LER'S STATEMENT: <br /> Depth .t IN water was fins found �' 'y It Thir welt was drifted under my jnriadiciion and this report is trur to the best of <br /> T ' perforating evA baEon perfondng �o' � my knowledge and belief• <br /> depago <br /> Ad end sperforating /.da d� feeNAME ted n, firm. or o poen �� > <br /> Address out �TYPed ee enticed) <br /> ( 10 ) WELL TESTS: <br />!, Vas a pwup test roldet ❑ Yes ❑ No If yes, by whom? _ <br /> e�Yield , nal./min. wish fr, draw down afterhn. [StGNan]_.t— _.._,___,_ - <br /> Wrl? <br /> \ TmP•rasun 97 water Was so chemical analysis made? [I Yes No Licenseparc <br /> Nv.._....._.__,__. <br /> ...._.._._ <br /> Was dmtrir/leR made of well? C) yes ❑ No svaas a n non evi po <br /> • / ttAn OWR 188 (REV, a.eq) <br />