Laserfiche WebLink
LOCATION NOT EHEC, , <br /> oRltetNAL - WATER WELL DRILLERS REPORTDo Not Fill In <br /> File Original,Duplicate and Triplicate with 1he (Sections 7076,7077,7078 avatar today 1�I�T? 53179 <br /> REGIONAL WA'T'ER POLLUTION Stare Well No <br /> cONTROL BOARD Nd STATE OF CALIFORNIA <br /> �(Iwsrerf spproprtaL anmbrr) ) � �(/ � Other Well Na._I��.� <br /> OWNE 0 1) WELL LOG <br /> Name real depth r' <br /> p }/ � ft Depth of completed veil f <br /> Address - r h Formation Dr—rsbe by rotor rrereri— rr-e of melerlef and rernetyre <br /> Ft to fr <br /> C � <br /> (2) LOCATION OF WELLrV <br /> n s <br /> County , ! Owner t naarber if nay— <br /> k F U or, N <br /> G <br /> Z.7 <br /> y 4 <br /> (3) TYPE OF WORK (check)New well X Deepenutg ❑ Retondtuarung ❑ Abandon ❑ <br /> If abandotsment,descrrbr materldl and procedure in Item I I <br /> (4) PROPOSED USE (check). (5) EQUIPMENT. <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation ;( Test Well [DOther ❑ Cable <br /> Dug Well <br /> (6) CASING INSTALLED' If gravel packed - t <br /> SINGLE]4 DOUBLE,7 ISA t� <br /> Garor Diameter from to <br /> From ft to ft Dam Wal] of Bore fx fr <br /> Amok e)17�2 <br /> I ype aed ate of shoe ar well nng �' S/X�� Size of aratel <br /> Desucbe)o,at <br /> (7) PERFORATIONS: <br /> Type of perforator wed <br /> Size of perforxtionr in,Iergeh ble sn <br /> Froffn rr to ft Perf per row Rom,per ft <br /> (S) CONSTRUCTION - t <br /> 1 <br /> eurtacr samcary$ell pronded? � Yes � L7No To whae depth 2 ft c ct '-Wv � <br /> LY <br /> 'mere any strata u.1ed tgunsc pollatiwo? C1 Yea C3 No if yes mace depth of aerate <br /> From It to ft <br /> .11cthcd of Sealsilg Work atarced � 1�,1�'- omp eted -2 <br /> (9) WATER LEVELS- WELL DFULLER'S STATEMENT <br /> ) Tbss well war drXed uuaer my rxrrsdection antrue to Ibis rr ort is trto the best or <br /> Deoto at which water vas fsr.t fogad <br /> my knowled a and belief <br /> `reins Level before paforanng <br /> NAME F _ G� <br /> "dine level ab..V.J*MMaMR G1 ft w <br /> c.,n 5 un 7 Typaa or Pr,wsror <br /> Address L� ar 1i <br /> (10) WELL TESTS: — <br /> �a.a pwnp lest modes ❑ Ya 0 No If yea by whom? M1 s <br /> Yield gal/mem with ft drams down after bra <br /> ESIGNED] <br /> V Driller <br /> Temperature of waxer Wa.a chemical aaalyart made? [] Yee C3 Na �/7 a <br /> License Na Dated , 19 <br />