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• <br />0 <br />• <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 I �) Z. 5 L-' — .. <br />Yes <br />No <br />A water well is present on the property <br />0 Dome sticlDrmking water well <br />0 Agncultural/Landscape water well <br />0 Unknown <br />Yes <br />No <br />0 <br />LtZ <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 <br />Signature <br />�R <br />Date <br />