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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 900 <br />Rancho Cordova California <br />(996) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address 3 S �. H 'R. iC..A.) <br />W -O/)/ 0.4----QSra. q 0 <br />Yes No <br />0 L?!q A water well is present on the property <br />0 DomesticlDrinking water well <br />0 Agricultural/Landscape water well <br />CKUnknown <br />Yes No <br />0 EK 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 t94*kk <br />Signature - <br />Date a. 0� <br />0 <br />