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-. <br />'^ <br />"R^G""°L STATE OF CALIFORNIA. ~~^ - <br />File Original, Duplicate and Triplicate WilhThe Ds������m�or�oou��o��o <br />D��NROFYUIE8os0��� <br />,,0'BOX 1oza DIVISION ��� \�N�t[� D���1R�CE� <br />^` <br />SACRAMENTO s.cAuronv/A / -' '''''-'' ---- -~ —' <br />` <br />40" —(Sectio= 7076s 7071, 7078, Water Code) ^^�.u/�� <br />�0-ATIMMyTr <br />SsmsT1 <br />------'-- <br />State Well <br />Other'Well No <br />Region <br />(]� (�� oo or Driller: : (3) Equipinent used <br />Name <br />7]j Domestic [] Municipal [] (check): <br />Irrigation 0 Industrial [] Rotary <br />' <br />Domestic and Test well [] Cable <br />Irrigatio <br />Other <br />Reconditioning of well <br />El <br />Total depth of well I such as silt"Peat, muck, <br />Give details of formadons ponetr <br />stone, hardpan, rock. Include size of gravel (diameter) and sand (fine, medium, coarse), color <br />Depth From Ground Surface Of MAter1d, structure (loose, packed, cemented, soft, hard, brittle). <br />(6) Casing eft in well: <br />LE14GTH DIAMETER <br />INCHES <br />---^=-'-- ---r-�--- . <br />A���� ---------- ' <br />-------'--- -'-'-'----' <br />p/nwLe DOUBLE. WELDED. <br />LES. PER FOOT OR SEATING BELOVV <br />GAGE OF CASING GROUND SURFACE. Fr. <br />---'---------- <br />Type and size vfshoe orwell Yes [] INO <br />o/mR.FORM No. z4v REGIONAL WATER POLLUTION mozzRoc uoaoo covz <br />'---'-- <br />'----- <br />'--- <br />--'--'--'' <br />--------- <br />--------' <br />If additional space is required, continue on DWR Form No, 246—Supplement, and attach to respective report copies. <br />(6) Casing eft in well: <br />LE14GTH DIAMETER <br />INCHES <br />---^=-'-- ---r-�--- . <br />A���� ---------- ' <br />-------'--- -'-'-'----' <br />p/nwLe DOUBLE. WELDED. <br />LES. PER FOOT OR SEATING BELOVV <br />GAGE OF CASING GROUND SURFACE. Fr. <br />---'---------- <br />Type and size vfshoe orwell Yes [] INO <br />o/mR.FORM No. z4v REGIONAL WATER POLLUTION mozzRoc uoaoo covz <br />