Laserfiche WebLink
bUPLIL"A.}E ''A + gyp.. STATE OF CALIFORNIA <br />file O(iginal, Dq laite and Triplicate with the DEPARTMENT OF PUBLIC WORKS <br />DIVIS10f V/70 RESOURCES DIVISION OF WATER RESOURCES <br />P. O. BOX 1075+ <br />SACRAMENTO45. CALIFORNIA <br />WATER. WELL MILLERS REPORT <br />d <br />(Sections 7076, 7077, 7078, Water Code) <br />i. <br />(I) Driller:.'" <br />�-- <br />Address+)-#—;.:�:- <br />License No... ,,� �t���*;� __._Classifteation.... <br />3 <br />.�S) Well log: <br />Total depth of well.. fit. it. <br />Depth From Ground Surface <br />/...... ---- ft. to ...... .._. _.f C. <br />. x a--------- - <br />„ ,. <br />Is <br />--... <br />........ <br />» » - <br />,r <br />» <br />::i » » <br />------- — <br />Is <br />F <br />------- - <br />), <br />» <br />» „ <br />$I-IF.E'11 <br />39-651 <br />+ Do Not FiIT In <br />'�N 5 -I6`Sf <br />Other Well No.�_% __ �7__. 0 <br />Region__— <br />(2) <br />(2) Proposed use or uses (check) : (3) Equipment used <br />Domestic Municipal ❑ (check) : <br />Irrigation ❑ Industrial ❑ Rotary ❑ <br />Domestic and Test well ❑ F. Cable <br />Irrigation (3 Dug well' lJ <br />Other-__- ___._ _._.__.___. Other.—___y-. <br />4) Type of work (check): <br />New well Reconditioning of well ❑ <br />Deepcni existing well ❑ <br />Give details of formations penetrated, such as silt, peat, muck, sand, gravel, clay, shale, sand- <br />stone, hardpan, rock. Include size of gravel (diameter) and sand (fine, medium, coarse), color <br />of material, structure (loose, packed, cemented, soft, hard, brittle). <br />01111 IS 1W. i %10 FAT i Us I ral I1 IMTRWIM <br />If additional space is required, continue on DWR Form No. 246—Suvillement, and attach to respective report copies. <br />Is <br />(6) Casing left in well: <br />LENGTH DIAMETER SINGLE. DOUBLE. WELDED, LBS. PER FOOT OR SEATING BELOW <br />FT. INCHES OTHER GAGE OF CASING GROUND SURFACE. FT. <br />---- ................_ <br />--------- _ _ - -- - ------------ --------•-•--------- <br />Type and size of shoe or well ring___'Welded joints—Yes ❑ No <br />POR -4 No. 246 27?11 2-e0 40A 7UIN SPO <br />