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• <br />is <br />WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3097 Kilgore Road, Suite 900 <br />Rancho Cordova California <br />(996) 869-0400 <br />May 10, 2000 <br />Well Survey Site Address ;16(-. Gv-t r_ f c. c _ <br />0 Yes ff�fA <br />water well is present on the property <br />DomesticIDnnking water well <br />Agricultural/Landscape water well <br />Unknown <br />Yes No <br />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 <br />Signature <br />Date <br />} <br />