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aj� ; ' <br /> CRlGINAL, WATER WELL DRILLERS REPORT� Do Not Fill to <br /> Me Qrlylnal,Duplicate acrd Triplicate with the (Sectio..706,7077,7072,ev„ar cod <br /> ce) Na 96605 <br /> REGWATER POLLUTION STATE OF CALIF <br /> OR <br /> ap },f �'� +` • <br /> CONTROL BOARD No-— r� ORNIA stare Well No.. <br /> •!'jeer!sypra>tis'iatr•r+srar ,� '7 � J �J �-____.__.._. <br /> Other Well No <br /> OWN R: <br /> Name (Y 1) WELL LOG: <br /> Total depth ft. Depth of twmplered rel] U ft. <br /> r3ddre55 Formation; Drcn,3r 1•y cc, ,r6.rnrtrr,ri=[cj t.. ia1,and cf <br /> fe.to fr. <br /> i <br /> (2) LOCA ION OF WELL: I <br /> EEE �j tr` Owner's camber•if aay— � <br /> R.F,A.or Street leo. ' <br /> i(3) TYPE OF WORK (check): <br /> a <br /> New well SK Deepening ❑ Reconditioning C Abandon ❑ " <br /> I f abandonment,describe materiol and proerdure its item 11. <br /> 21 <br /> (4) PROPOSED USE (check): (5)- EQUIPIMENT: " <br /> Domestic 'Industrial E] Municipal 1 Rotary � � ae <br /> i Irrigation ❑ Test Well ❑ Ocher ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE DOUBLE i 7 Ga e <br /> I),amtttr from to <br /> From fc.to ft. Dian. 013 of Bon ft. ft. <br /> Type and size of shoe or eve1F ring Size of brs7el r ,• •• <br /> Describe jour <br /> (7) PERFORATIONS: <br /> Type of perforator used •1 <br /> Size of perforations in.,length,by in, ,. <br /> From ft.to ft. Peri.per row Rows per it. <br /> zz <br /> (S) CONSTRUCTION: <br /> Was a surface sanitary tell prodded? trct 0 No To what depth f[. <br /> Were any strata sealed against pollution? Yea ❑ No If yes,note depelt of rrnta <br /> From fc w ft. <br /> Method of Sealing work started—.—. i9 completed 19 <br /> (9) WATER LEVELS: ._'_ WELL DRILLa STATEMENT: <br /> Depth at which water was first found r it. This we11 was drilled sudrr my iurisdiction and Ibis report is j'rur to the best of <br /> 7ny k"owledge and belief. <br /> Stradiaalerelbefarel,erStjnX6 - - it. NAMh ALTER G. NOACK & SON; INC., <br /> lerelafter perfor*ratia ''�� •/'�. .., <br /> ft. <br /> ,q6Q8tr0q °1?P4'F–iVIDNT$Td oor prirted} <br /> (Ta) WELL TESTS: Aaanas <br /> bas a pump test made? 0 Yes -15Ae 1£yes,by whom? <br /> Yield'e` gti./mio. with ft.draw down after <br /> ' ell Dr <br /> Tonpor ure of water Was■ahensiial snslysit made) © Ye[ No License No. ..... Date _ <br /> _... . ................ 19. '. <br /> Wareleetrie log made of well? 0 Yet YNo -- <br /> $702111 s-a7 eau 0u1N A■.o 13WR Inn impv v,Kdt <br />