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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 100 <br />Rancho Cordova California <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site AddressUA <br />Yes No �� dF LGA W A <br />A water well is present on the property <br />0 Domestic/Drinking water well �� 1 <br />Agricultural/Landscape water well rr r <br />0 unknown W `CL <br />Yes No -3 <br />Q Is the well being used ? IM <br />'1 <br />If known, please provide well construction details /� i�-- <br />Date installed <br />Depth of well <br />Casing Type <br />Casing diameter <br />Screen interval <br />Survey completed by <br />Name 9W jq <br />Signature <br />Date <br />• <br />