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OWGINAL <br /> ' file Original,Duplicate and Triplicate with the SHEET 2 <br /> DIVISION OF WATcR RESOURCES <br /> P O BOX 1016 <br /> SACRAMENTO 3 CALIFORNIA <br /> l WATER WELL DRILLERS REPORT Do Not Fill In <br /> (Sections 7076,7077,7078,Water Code) State Well No <br /> ' Other Well No. __ ______ <br /> Region---------- ------ -- ------------- <br /> (7) Perforations- <br /> Type of perforator used...__—_—�_ -- - ----- -_- --- - — _ _---- -------- _—_ -- --- --- - -- <br /> Perforated_____ ______.—_____ft to_—____________—____r__Jt Hole s>u_ —__ __-- __No of holes —- ---------___ <br /> ----------------------- ---------------------------- ---------------- ----------- ------------ <br /> --- -- --— --- - <br /> - <br /> ,. ., „ <br /> -- ---— __ -------------------- -- ----- - - - --------------------- <br /> _--_______________ <br /> w <br /> (8) Water levels. , n (9) Well pumping test: <br /> ' Depth at which water iol f, J1 _` Date of test— —By whom___-_—______ ____ —_ -------- <br /> first encountered__—__ �y'; —M1n 1 ft Depth to water when test started <br /> Depth to waxer .r -s �'ft'�.� G P M at beginning of test—__.._—,_.._-------- ----- -- --- - - - -- <br /> ' before perforating__________ ___________—___ ft ' - Drawdown from standing level--___--_—_______—__________—__it <br /> Depth to water G P M at completion of test_—_-___ _- <br /> after perforating__—__—_—_--____--ft Drawdown at completion of test_ —__________________ ______--_—ft <br /> Note any change in water level while drilling Length of time tested _— <br /> �» Temperature of water--- <br /> Was <br /> ater-_Was gas present in water) ❑ Yes ❑ No <br /> (10) General: J <br /> Was well gravel packed) __----_—.....Size of rock—____--_--_--__ Tluckness of pack <br /> ' Was a surface sanitary seal provided? <br /> Were any strata sealed against pollution? ❑ Yes ❑ No If yes, attach detailed description. <br /> Strata sealed _ __-____ ____-- _____ _____ <br /> ' Was analysis made of water? ❑ Yes ❑ No If yes, attach copy - <br /> Was electric log made of well? ❑ Yes ❑ No If yes,attach copy <br /> If well abandoned. was It plugged and s=led)-- <br /> Method <br /> ealed)_Method of plugging and sealing-_—_ _— <br /> ' (11) Location: (12) Tune of work: <br /> Nortb Section No_ Work Work started date ��'3�l�owleted date—�13-- <br /> ' Township—_ Date of tins report <br /> Base& WELL DRILLER'S STATEMENT <br /> Show location of well in Sec- This well was drilled under my jurisdiction and this <br /> tion,thus ()() report is true to the best of my knowledge and belief <br /> Distances 5o section lines from <br /> ' well, Xor S ft. [SIGNEDI Stockton Arma. tune & Motor Works <br /> and Itor W._._L-Q-ft WIIEDrdirr <br /> Show Iocation of nearest By__ --- - ?___-- <br /> known well, thus (0) License No _b7850 Classificatl -57 <br /> 1 MILE Distance to nearest known _ <br /> well____ _ __ it Dated____ �_ _ 19 <br /> D w R FORM No 246 REGIONAL WATER POLLUTION CONTROL BOARD COPY 2317,13 30 40M QUIN SPO <br />