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ORIGINAL T iNnL WATER WELL DRILLERS REPORT File Original,Duplicate and Triplicate with the `,Do Not F:'ll <br /> U <br /> REGIpNAL WATER POLLUTION I <br /> (Sections 7076,7077,7078,'pater Cad.) � 56595 <br /> • <br /> CONTROL BOARD No. 12STATE OF CALIFORNIA State Wep No._ &A4 egL <br /> . •e approprlatr narybar) "C <br /> OWNER: Ocher well No.---.- <br /> i) OWNER: <br /> Nam (11) WELL LOG: <br /> eall 111!� <br /> cD Total depth fr. Depth of completed vt(1 tt G fiAddresstR'� Farmnion: Desrribr 67 co7w,rbrrarrrr, i'r <br /> s- of marrriat,and srrarrarr, <br /> to ft. <br /> (2) LOCATION OF VEL _2 — <br /> county Oxncr's nvmbsr,if suv— - 6— -•2 <br /> R.F.D.or Steer Jf•� .1 L� <br /> !/ _ � ``-•Pour <br /> d :c <br /> (3) TYPE OF WORK (check): 2-1 z <br /> New well'% Deepening ❑ Reconditioning ❑ Abandon ❑ - 4. <br /> OL3 <br /> If abandonment,describe•neaterial and Procedure in Item Il. <br /> (4) PROPOSED USE (check); (5) EQUIPMENT: 2– <br /> Domestic [:] Industrial Municipal Rotary [] a - <br /> Irrigation ❑ Test WelI U Other Cable � 52p A•qp <br /> Dug Well Zf� S. 2 •, <br /> (6) CASING ITV"STALLED: If gravel packedSINGLEE] DOUBLE' — <br /> Gage l.G <br /> Fromr Diameter from <br /> (t <br /> .m ft. Diem. �•a11 of Eore ft• ft, <br /> 65- > yl <br /> Type and nx of that or well ri g'/`r/� Sae of grsveF: ' <br /> (7) PERFORATIONS: <br /> Type of perforator uud 75 � •• <br /> Size of perforations ia.,IcnBth,by <br /> From rr.•. t. fo IA. <br /> .. <br /> ... ..........'14' <br /> (8) CONSTRUCTION: <br /> Wal a surface sanitary seal pro.idedt ❑ Ya ❑ No To what depth ft, 11 <br /> 'Were nay strata sealed against pollutioa7 Yes '• " <br /> C) No If yrs,note depth of strata <br /> From ft.to <br /> ft. r <br /> . O ow p <br /> Method of Sealing " <br /> �• Work started _ tp19 tom Seted } / <br /> (9) 'WATER LEVELS:; WELL DRILLER'$ STATEMENT: <br /> Depth at which water wan first Fouad $ Z This well was drilled tinder my jurisdiction and this report is true to the hest o1 <br /> ft my knowledge and belief, <br /> ae lapel before prr(wrstiag .� � <br /> or it. NAME " <br /> 4'etei after perforatin8 4 �'L'� t <br /> .! it. Sh,ta6n,ti �V 1 <br /> rm,or carP�raia,n, --r77pr or p•,,,,rrJ <br /> (10) WELL TESTS: Address } <br /> Wass pump test rpidei ❑Ya CINo If yes,l whotal <br /> Yield: / gal./thin.with ft.draw down after hrs. $fGNED ..............._-... f� ' <br /> J <br /> Well Diller -- <br /> empenture of water �, - _.. <br /> Was s chemioa[aaalysir medal ❑ Ya Q No <br /> License No--------------....-....— .............. Dated-.-..-_. <br /> Mar dretric los:made o!well) <br /> ❑ Yes ❑ No --- <br /> / 57025 8-97 6oM QVIN(�Oro <br />