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ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill In <br /> �l{a Arigina?,Duplicate and Trlplicata with the .L IUD o 113584 <br /> REGIONAL WATER POLLUTION <br /> (Sectinpa 7079,7077,7079,Weser Cade) • <br /> CALIFORNIA <br /> THE RESOURCES AGENCY OF CALIF �,S"`° ell N°•__ _1_____ .� <br /> CONTROL BOARD No, __- —_•-- <br /> t sPprePrisir sisimber) Other Well No.-----------------------_--___--.._- <br /> 1 OWNER: (1 l) WELL 'LOG: <br /> Name C lif0I'I7ia Water Service Co. Total depth ft. Depth of completed well it <br /> Addres, 17e O L-).x 1-150 Formation: Drtcribr by color,cbsrsrtrr,size of ms4frisl,sod rlrssetxre. <br /> f[•to ft, <br /> (z) LOCATION OF WELL: <br /> County Owner's number,if any— �1 <br /> R.F.D.or Street No. Wilgoll '�tia ' <br /> a <br /> back Ahandon hy sealinF tlith <br /> of original of this report) „ P=p from <br /> „ .� r� <br /> (3) TYPE OF WORK (check): <br /> New well ❑ Deepening ❑ Reconditioning ❑ Abandon]U <br /> If abandonment,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: " <br /> Domestic Industrial ❑ Municipal (] Rotary <br /> Irrigation [ Test Well 0 Other Cable ❑ « <br /> Dug Well 11 <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE Q DOUBLE 0 Gage " <br /> Fromor Diameter from to <br /> ft. Diem. Wall of Bose fr, ft. <br /> Typc snd size of shoe or well ring Size of gravel: ' <br /> Describe joint <br /> (7) PERFORATIONS: <br /> Type of perforator used <br /> Size of perforations <br /> ln.,leoq[h,by t4• <br /> . <br /> From it.to ft. P<rf. r <br /> Pe row, Row[per ft. <br /> (s) CONSTRUCTION: <br /> Was a surface sanitary zeal provided? ❑ Yes ❑ No To what depth ft- <br /> .j'1Tr'9 'r' J <br /> Were any strata anled against pollution? <br /> Yes 0 No If yes,note depth of strata t` 4.��1 �. <br /> f. <br /> [] <br /> From f,.to ft- " <br /> Method of Sealing " <br /> Work started 19 completed <br /> 19 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT; <br /> Depth at which water was first found This well w rt a under m jurisdiction nd this report is true to the best of <br /> f` ny knowle rand belie <br /> Indinr level before perforating ft <br /> NA :--11 001It 2`Tl r <br /> ing level after perforating . <br /> pars f 1 rioted <br /> - 1 -t( r cot ati <br /> (Typed or <br /> ftAddr s ash Ave. <br /> Printed) <br /> (10) WELL TESTS: {s <br /> Was a pump test made? <br /> ❑ Yes ❑ No If yes,by whom? 0 <br /> Yield: <br /> gal./min. with !t. draw down after hrs [SIGN � �_�_—_ <br /> . Weld Driller <br /> Temperature Of water Wae s chemical analysis made? C Yea ❑ No �� <br /> License No.—_ "—`f� _ Dated--r -{7p 6g <br /> Was electric log made of well? ❑ Yes ❑ No <br /> 07e40 0-e3 36M QUM Q Q exp <br /> — Cw3t 188 fl+ev, 3-R41? <br />