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, <br /> Fila Original,Duplicate and WNU 55306 <br /> Triplicate wllh the (sections 7070,ropy,1078,'Water Code) <br /> ' REGIONAL WATER POLLU'T'ION � <br /> CONTROL ROA STATE OF CALIFORNIA y State Weil No /rte C _ It~ <br /> rept epproprlelr nab")' No j Othe Well No <br /> fie, <br /> SA- « �- <br /> t I) OWNER (11) WELL LOG <br /> 1me / <br /> Lt'L�-G�4 , Total depth t3-14 It Depth a[rnmQtrted well /"}—eq #r <br /> ddress / �� Formation Derrribe by color rb¢r✓rter ere of rrrelrnal And tlractope <br /> a ) R to It <br /> (2) LOCA ION OF ELL <br /> County + Owners number 4 env-- <br /> R P D or Sue NoC re- <br /> (3) TYPE OF WORK (check). qj .w <br /> New well Deepening © Reconditioning ❑ Abandon ❑ <br /> 11 abandonment,dercrtbe material And procedure sn Item 11, /w Z <br /> (4) PROPOSED USE (check) (5) EQUIPMENT 2�L '. <br /> Domestic 0 Industrial [❑ Municipal ❑ Rotary 91 -1 / <br /> IrrigationF-1Test Well ElOther 13 Cable ❑ /�f� ��G <br /> Dug Well ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE A DOUBLEiast <br /> or D-Ma Ter from to <br /> From Oft to It z Diam Fall of Bore ft ft <br /> i - <br /> Type said site of shoe or cell rtaa �1 5..e of ara+el <br /> Duel...fatot � _--� <br /> (7) PERFORATIONS: <br /> Type of perforator tared <br /> Sue of perforations in. length br.— sa I 1 �r t " <br /> From It to ft Perf per row Rows per it � <br /> (s) CONSTRUCTION: <br /> VAX a surface unitary teal provided? ❑ Yea ❑ No To what depth it <br /> Wave star strata sealed a6atmc pollution? l(Yet ❑ No if yet cote depth of strata ---- -- <br />' From C! ^it to 57 ft <br /> Method of Sealing Work started /Q l9 C'.omp,e cd ZZ 1 194�Q <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> / Tbtr well was drilled under my jurisdiction and this rrPori is true to the beat of <br /> Depth at which wirer via first found j it my knowledge and belul <br /> nding level before gerforattnR ft NAME <br /> Jing level after perforating [t l!'raon firm t r wrper.tm i t]tprd tar gr'+tel) <br /> Address <br /> �0) WELL TESTS: <br />' <br /> Was a pump east made? ❑Yes ❑ No If yes by whom? <br /> e [SIGNED] <br /> Y&did r r <br /> Rail/min with ft draw down sitar lips Writ Dnl .. <br /> Temperature of water Was a chemical analysis made? ❑ Yet ❑ No License No _ bated _ , 19 <br />' Was electric log made of well? 0 Yea 0 No 57023 9 37 SOM gUIN A SPO DWR 188 (REV 3 sal <br />