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0 <br />WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 100 <br />Rancho Cordova California <br />(916) 869-0400 <br />May 10, 2000 <br />r' <br />Well Survey Site Address <br />Yes No <br />ffA water well is present on the property <br />0 DomesticlDrinking water well <br />Agncultural/Landscape water well <br />Unknown <br />Yes No <br />0 G21 <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 />Name r rJ :5V -- <br />Signature L4��� <br />Date _ Q -D <br />0 <br />