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'1 <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not F:21 In <br /> U <br /> File Original,Duplicate and Triplicate with the (saet,nns 707'49,rer�,7079 water Col NY 55273 - <br /> REGIONAL WATER POLLUTION State Wel!No <br /> TROL STATE OF CALIFORNIA <br /> �^ BOARD No f Ocher Well It3o_ <br /> approy...is o•-ber) <br /> OWI`y R (1 I) WELL L//OCG: <br /> Marne Tota!depth ��7 it Dept],of compl,ted .yell <br /> Address 3 O Formauon Dnr,hr ri�ro'ar rbar.rier ucr of swirled, ,rrrrfx,r <br /> ft to It <br /> (Z) LOCATION OF W d <br /> [qvpO,aatr+run her if sour y <br /> R F D or S r <br /> (3) TYPE OF WORK (check). <br /> New well G Deepening X Recondrt,onmg t7 Abandon <br /> 1f abandon-mrnl dnrrsbe-material and procedure in Item 11 <br /> (4) PROPOSED USE (check) (5) EQUIPMENT —_ <br /> Domestic ,17 Industnal ❑ Mi niclpal L Rotary <br /> Cable <br /> IrngationI Tee;Fell C Other ❑ Due Well <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE s DbUErLE _ Gage <br /> ,` Dameser f oro [o <br /> oof Aorr f, <br /> From ft ,o rt D..m �alr ft <br /> Tip-and of shu or well ring I'g S'"of gra"I <br /> Describe iwoe <br /> (7) PERFORATIONS <br /> Type of p-rforntor wed / <br /> Size of perforations m len;,h by in <br /> From ft fi rerf per ro, Rr,x per it <br /> (8) CONSTRUCTION- rnr n rr i n r 1 t+n <br /> a a.a ..,face .anrtary seal pro_ded? ❑ Yea ❑ No To ,ha[ dept? ft <br /> Vere any areata.t Jed against poll mon? Rra D No If yo, bate depth of strata <br /> From t, i. it <br /> L7 7— <br /> MethoMethod <br /> d of Sealing work etanrd 1 i9 Comp+ned ! �° 4 <br /> (9) WATER LEVELS 'WELL DRILLERS STATEMENT <br /> (� . This well was drillyd wndrr in-o jurisdiction and this report is ftwr to '-be brsl of <br /> D!ah at wh,eh eater was fir,t found / .7y It m.) kknou'leil d beltef <br /> Uf / <br /> g!cr•r!before perforat'ng it NAME t <br /> lees]a ...perforating ft .rwr+ rm air wrpC-r}a11.,r,3 lr1 Tn. 1J <br /> Address <br /> (10) WELL TESTS- <br /> Was a pump teat made? ❑ Yet ❑ No If ya by-?,om? <br /> Ysrld gal/man -,ah fr dream dbw,n after bre well Drilfrr <br /> Tosape..lure of_.ter Was c cheaueal ail mads? Q Yn ❑ No License No — — Dated— <br /> Ira,elretne lax made of m,sl ❑ Yn ❑ No <br /> 07.26 a e7 sOM a111N Q VO DWft 188 (REV L St) <br /> fa` _ <br />