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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 100 <br />Rancho Cordova Califomia <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address T i n <br />{ i <br />Yes No <br />0 A water well is present on the property <br />0 <br />Dome sticlDrinking water well <br />0 Agricultural/Landscape water well <br />Unknown <br />Yes No <br />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 />'/71/ Y! <br />Name <br />Signature <br />Date r - (, )C) <br />