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File Original,Oupiluts andTriplitate with the (8ecttoos 7076,7077,7071,waxer Ceaa) - --- NO 39892 <br /> Z r <br /> RErIONAL WATER POLLUTION - M <br /> CONTROL BOARD No 1 STATE OF CALIFORNIA � seLLLAII 1 o- <br /> ••aurr sppraprlah naaebsrlf - <br /> t other Well No <br /> �) OWNER• (11) WELL r�LOG <br /> Name 1Z ron Peters Total depsh 200 ft Depth of completed well 200 ft <br /> Mddress Rte i Box 1695 Farmsxtont Dex-rlbe by calor,cbaractn,the of naeterler,end tlrgelatf <br /> aatriro D caiii. n it ro r fx Soil <br /> a <br /> (2) LOCATION OF WELL- 3and <br /> County tJ an Oct,—uin Owner i number if any— soft. -I <br /> 1 R P D or Street No (ti• ox 1695 EatEro-o 5 0 56 B I ue saad <br /> rilIgs Re . '' a <br /> TIS RbE <br /> QQnarsa sand <br /> rtr <br /> (3) TYPE OF WORK (check)• t `yam <br /> a <br /> New well C9 Deepening ❑ Aewndanonmg ❑ Abandon ❑ 10 <br /> 7 <br /> if aband&mwent,describe material end tracedure is item I1 --a All hard nan <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: <br /> ' Domestic ❑ Industrial ❑ Munk:pal ❑ Rotary ❑ <br /> Irrigation [ Test Well C3 Other El Cable [ _ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE�n DOUBLE❑ Gage <br /> or Diameter from to <br /> From it to ft Dunt Wall of Bore it it <br /> Ll <br /> Type sad size of show or well tins x �� Stu of ars,el <br /> Describe resat 1Tm e <br />' (7) PERFORATIONS: <br /> Type of perforator used __ 5 <br /> Size of perforations 3 '16 m,length,by 3 lo. <br /> From ft to f, Perf per row Rows per it <br /> 95 10? <br /> '1 In 11 <br /> 1 164 <br /> O v 120 <br /> (8) CONSTRUCTION.- <br /> Was <br /> ONSTRUCTION:pa a surface sanxsary real provided? ❑ Yea 5t No To what depth is <br /> Were any xtraca as"almost pollution? ❑ Ya Iallo If ya,note depth of strata <br /> rFrom it to it <br /> Method of Sealing Work nartad 9 5 2 mplated 9710752 t9 <br /> (9) WATER LEVELS: WELL DRTLLER'S STATEMENT <br /> This well wits drilled :ander my lurtrdaetton awd this report a true to the best o <br /> Depth as which water was first found 27 ft my knowledge and MW <br /> s•andtas level before pefarstma It. <br /> NAME Clark `j ell Dra.11ing Co♦ <br /> adta;level sfta perforating , <br /> ix w <br /> tPern hrm or 4orpersuun p ,:yard of prl�-ntsll <br /> Address 2V <br /> 0 la E. Charter #air <br /> o) WELL TESTS: S crcton 6 Calif. Of <br />' u a pump the made? V Yn Cl No If ya,by whow? a—.G• -&, E. _ • „•-Y•� <br /> Y,eld161 <br /> r gal/sous with 2after his [SIGNED]Q <br /> � ft draw down 7et1 DraUn <br /> Temperature of wt,xer Was a.hernial analysis made? ❑ Yea 2 No License No 76602- Dated - _9A_0157 ,19— <br /> TAI electric lo;made of well? ❑ Ya ]S No vises 3 54 30M atim T sra DWR FORM No 2d6 [RaV 3 34 <br />