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WATER SUPPLY WELL LOCATION SURVEY FORM <br />Well Survey Site Address <br />SECOR International <br />3097 Kilgore Road, Suite 100 <br />Rancho Cordova California <br />(916) 861-0400 <br />May 10, 2000 <br />�3 5 <br />/'k, �I t CA I b <br />Yes No <br />0 0 A water well is present on the property <br />0 Domestic/Dnnking water well <br />0 Agricultural/Landscape water well <br />© Unknown <br />Yes No <br />0 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 i D 1 Ruob" <br />Signature ,-- //- V�' v- - %-� <br />Date / 00 <br />• <br />JUN - 5 <br />