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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3097 Kilgore Road, Suite 100 <br />Rancho Cordova California <br />(916) 869-0400 <br />May 10, 2000 <br />Well Survey Site Address /"/`� �I/''����� _d r'z Lee - <br />Yes No <br />0 JXJ A water well is present on the property <br />Domestic/Drinking water well <br />Agricultural/Landscape water well <br />0 Unknown <br />Yes No <br />0 Is the well being used ? <br />If known, please provide well construction details <br />Date installed <br />Depth of well <br />Casing Type <br />Casing diameter <br />Screen interval <br />Survey completed by <br />Name 41r`C III � /-7-//// <br />s <br />Signature <br />Date '5'- / - (�2 0 <br />0 <br />