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File Original,Duplicate and Triplicate with the WATER WELL DRILLERS REPORT Do Not Fill In
<br /> REGIONAL WATER POLLUTION --
<br /> (S•eCtiaYe 7016,7077,7079,Water C-d.) 1 NQ
<br /> �1 •
<br /> CONTROL BOARD No. STATE OF CALIFORNIA l State Well No.j-N _- C,,�— (Z
<br /> horns epproyrtate attmberJ f G /_-,
<br /> w•
<br /> J eee»> Other Well No.--------------------
<br /> r i OWNER: (11) WELL//LOG:
<br /> Narne I,• Total de th 540 ft. Depth of completed well 530
<br /> p fs.
<br /> Address T3 Formation; Drrc,,br by color,chererrn,rive of useJnial,and rHartarr.
<br /> 0 fr.to 6 ft3llack Adobe
<br /> . liF 16 "Brown Cl, parti.c es 1 Zne ,5anc
<br /> (2) LOCATION OF WELL: 21 'Fine Yellow S and
<br /> Co°n[y S Owner's number,if any— 1119-0134 r1 "lel. C11, Parti Cles Fine
<br /> R.F.D.Or Street No, ? -A0 'Brown Sand', , Parti elesBrown .L
<br /> 0 70 -Brawn Clay, nartiel.es Fine an
<br /> 20 80 ' it 10 ptrticles Coarse 2;
<br /> 0 'Soft Yellow Clay
<br /> 100 I;L3 -Yel. Cl, particles Coarse Sanc
<br /> (3) TYPE OF WORK (check): „ S "soft Ir-"I . Cl. part. Fine S and
<br /> New well 91 Deepening [) Reconditioning-0' Abaadop ❑ 178 0 "Yel & Gre CaL. to FineSanc
<br /> "Coarse Sand, 37artiCleB Yea a Cl
<br /> I f abando+Jment,describe materlat andprocedurt iss Item 11. _
<br /> S E UIPMENT: 13 238 , ,Ye Cl. , Ioartielea Co&rse Sar_
<br /> (4) PROPOSED USE (check):
<br /> ( ) Q "Cemented Gravel & Boulders
<br /> Domestic ❑ Industrial ❑ Municipal ® Rotary El 'ne Gne-y Sand T
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cade ❑ "Cca.rse i<_ Tight Care Sand
<br /> Du Well ❑ particles Gr C1
<br /> ay
<br /> (6) CASING INSTALLED: If gravel packed -M2 ee Coarse Sand,-,art. Grey C1,
<br /> SINGLE [Z DOUBLE L-1 Gane _�a7 1459., a line Sand tr II 5
<br /> Diameter from to '� It !i
<br /> From °° -- g �r� 5 Free Coarse Sand
<br /> ft,to f Diam. Wall of Bore ft. ft. �-,_•
<br /> 190 - 80 11.15 G_17 Soft Grey C1,x -mrt. CoarseSat
<br /> q0", 80 15101,.`2 143 "'Far Grey r2 ay
<br /> 441 4L3 �5nf t rPy Ql ey.._.,-•rticl.es
<br /> — (Uoarve Send
<br /> -461 471 Caarae_EAndL_
<br /> Type and size of shoe or wdl rip ..c
<br /> g none Size of 1 T _ oarse S&.nC
<br /> Describe joint • TP- (� r re r
<br /> r�—�-So t.. -rpy Clry.
<br /> (7) PERFORATIONS: '—, --, - d,_ 14,q 7-rl 11rP7-r C-11 r. � -�arti Cl-S
<br /> Type of perforator VOW Factory louver .,
<br /> Size of perforations — in.,length,by t9 ia.
<br /> Froa;n200Ft.to 0 ft. 8 perf,per row Rows per it.
<br /> Es l
<br /> (8) CONSTRUCTION: $
<br /> Was s surface sanitary Beal pro.ided? $1 Yes ❑ No To what depth 80 ft,
<br /> Were say strata sealod against pollution? ❑ Yet a No If yes,nate depth of strata •,
<br /> From fr.to -4, ft, r• 1,y J
<br /> Method of Sealing 'x- _W_ork starteddV. ..d,—
<br /> completed i� g
<br /> rC1213,5Q(9) WATER LEVELS: fr WELL DRILLER'S STATEMENT: e
<br /> rT This well was drilled under my jurisdiction and this report is true to the best of
<br /> Depth At which water was first foun< not av:3 ab-1e fr• my knowledge and belief.
<br /> nding le.d beforeIt perforatin r
<br /> a t ft. NAME TtIE3=, T ?.iELL DRILLT!G CC'. i�D
<br /> iafi level after perforating 'e, f:•
<br /> J t Person,tirm,or coral n[,ou, r I'rPed at pra ntrdJ
<br /> Address p p pot
<br /> to) WELL TESTS: -�'
<br /> 47
<br /> SaCalif.
<br /> Oras a pump test made? M Yes {:) No If yes,by;darn? Driller
<br /> Yield, 1900 21 ft.draw down after 1 bra. I$sCNB�]._..-----..._,�
<br /> gal./min. with 0r17DrfGrr •---•--•----••---•--
<br /> Tnopsnt°re of water, Was a chemical analysis mads? ❑ Yet (I No N2152
<br /> License O. „--
<br /> -.....-... nand 5.`� .
<br /> WAS elecrric las made of well? Xj Yes 0 No 95609 3-5a 50M QUIN a i►O DHMR FORM NO, 246 tNEY. 3•546
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