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C <br />WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017101gore Road, Suite 100 <br />Rancho Cordova California <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address L2"C} 7 <br />Yes No <br />A water well is present on the property <br />0 <br />Domestic/Drinking water well <br />0 Agricultural/Landscape water well <br />• Unknown <br />Yes No <br />0 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 />� c <br />Name <br />Signature S�j� <br />Date <br />L _J <br />