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LOCA; <br /> .1RIGINAL WATER WELL DRILLERS REPORT TDo Not Fill Is <br /> File Origin.Duplicate and Triplicate with the (S.otioze Toys,7077,707S,'Water Code) lr 37295 <br /> REGIONAL 'WATER POLLUTION <br /> Wa�jL BOARD NO-�� STATE OF CALIFORNIASweeVellNo rfsfl Mnlbfr� 4 SOther Well N^ <br /> (1) OWNER: (11) WELL LOG: <br /> _ <br /> Name (J S'„$'p � / / „� 0 Total depth Tn it Deyth of completed well ft <br /> Address lf 1'7 d Q r y Fatmerioo Deter0w by ester.ebwfrfer,tar of,.otmal,and thrrhm <br /> L / , ft ft <br /> (2) LOCATION OF WELL: / j V - /,;:, - C ; <br /> caanq Sa 7) T 2 U �y�Owaer r acmbw if aa�— ! �`j r-ejy S C> <br />' A F D or Street No - --I L LG?CS Se 2?7 F <br /> i'°�`� '' 2 2 37 C -rem <br /> ` C <br /> 47 <br />' 7 <br /> (3) TYPE OF WORK (check): `}U a a x tr -� <br /> Ncwva1X"0 Deepe=s ❑ Rocondtnoatms ❑ Abaadon ❑ "-- <br /> ,it int,dncribe macrul sad Procedure on hese 11 <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic 0 Industrial [3 Municipal [-IRotary,4* f*r <br /> ❑ <br /> InrfgIrrigationE] Test Well ❑ Cable <br /> ❑Other Du Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br />' WHOLE®GaOUSLE GaSe <br /> 11 er Diameter from to <br /> rom/ to Z ft Dram �Z <br /> *—van of Ban It ft <br /> 7£ <br /> Type and size of sloe or well nal Sam of gra'ell :l <br /> Describe joint <br />' (7) PERFORATIONS: <br /> Type of paforaty used <br /> Size of perfectuora sa. b bs « <br />' From ft to f peri pct roe Rewe per fe « <br /> (B) CONSTRUCTION: <br /> Wm a earfau aastary Dal prmsdad? $Ya [I Na To what depth 2-5 <br /> Et « -- <br /> Were Coy strata maled.saran podutsoo l Ya ON* If yes,acre depth of strata <br /> From/MK ft to <br /> Method of Sealing Werk atart.a J✓ l / u D' completed <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT " <br /> Thu sf+dl was drdled under my jursi tetrow and?bet report is trite to the bell of <br /> th at which water was first feared It my knowledge and belkf <br /> 0111WtaS level before ptrforsttns it, NAME 6r, e 0 rC7 <br /> Andialt Ea.d afar perforattes ft (Person w eorvarutop) r7rNl or y..ruJ1 <br /> Address <br /> i (1 a) WELL TESTS: a �- <br /> Das a pump tan model 0 Xaa IW4o If To.by whom! <br /> Yields Dal/sato with ft draw dews after bra. [SwNEtD] —- <br /> � �sU Dr1Nev / <br /> T.mmwm <br /> pat .f waw Wa ehemied madras Mazda? ❑ Xis No Ltxnu No. ?1' C r7 Dpsed� <br /> ■'n eierene 1oR aside of wt111 Q Xa Na asset a 54 Som Gum @" sro DWR FO111a NO 246 MKV 3 541 <br />