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P.0. �ox <br /> SACIAMENTO p, CALIFOR NlA DIVISION OF WATER RESOURCES <br /> Do Not Fill In <br /> WATER WELL DRILLERS REPORT Stat, VNo------------------------------------ <br /> l <br /> Other ell <br /> .-r-- <br /> (Sections 7076,7D77,y07d;.Watet Cade) / <br /> Region---------- <br /> ---------------------------- <br /> (1) Driller-1 <br /> 2) Proposed r uses (check): (3) Equipment used <br /> Name `M �`' - --- �' ' Domestic u I cc <br /> .L , <br /> ❑o Municipal (cb k): <br /> ---- <br /> Address-- '1 `-== '��_�� 1- 1 <br /> --- -- - 1> tion � industrial ❑ Rotary ❑ <br /> ---ti--- ' �- �dt�lionZic and Test well ❑ Cable <br /> License No. _. __ __Classification_ _____________ <br /> liarigatio ❑ Dug well ❑ <br /> iQtl --- ---------------------------------------- Other------------------- <br /> Owner: - I <br /> \/Name--- pe <br /> of work (check) <br /> Address---- <br /> ------------------------------------- New well Reconditioning of well ❑ <br /> ------; ---------------------------------------------------------- ---- Dee ening existing well ❑ <br /> (5) Wel log: r' <br /> Total depth of well--- <br /> --------__`-----f t. Give details of formations penetrated, such as silt, peat, muck, sand, grave , clay, shale, sand- <br /> stone, hardpan, rock. Include size of gravel (diameter) and sand (Fine, medium, coarse), color <br /> Depth From Ground Surface of material,structure (loose, packed, cemented, soft, hard, brittle). <br /> A••------------ft. to-------_-3----------ft. <br /> ----------- <br /> 1P - f <br /> ,. <br /> 1P 1P <br /> _a <br /> .. N ,. AA- <br /> ; u <br /> ., ,. <br /> , <br /> r� , <br /> -- <br /> - ------------------ --------- -pmt• <br /> ------- <br /> ], ,. <br /> ------,. <br /> --------------- <br /> „ <br /> ------------------ <br /> ,. <br /> -- <br /> ,. ,I <br /> ----------------- <br /> ., , <br /> If additional space is required,continue on DWR Form No. 246—Supplement, and attach to respective report copies. <br /> (6) Casing left in well: <br /> LENGTH DIAMETER SINGLE.DOUBLE.WELDED. LBS, PER FOOT OR SEATING BELOW <br /> /y FT. -------INCHES OTHER <br /> J /' � ', �- GAGE OF CASING GROUND SURFACE. FT. <br /> ----T----eq- / <br /> --- --� LL----- <br /> -------------------------- <br /> Type and size of shoe or well ring.24 Welded joints—� Yes ❑ No <br /> O-W.R_ FORM Na, 24e REGIONAL WATER POLLUTION CONTROL BOARD COPY <br /> 0(jQ07?COMJ o y <br />