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• <br />• <br />0 <br />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 Address / �, 1� H"- 4-1 S - <br />Yes Na <br />A water well is present on the property <br />Domestic/Drinking water well <br />Agricultural/Landscape water well <br />Unknown <br />Yes No <br />Q 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' t,l� <br />Signature - <br />Date 5 —01 — DO <br />