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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Surte 100 <br />Rancho Cordova California <br />(315) 851-0400 <br />May 10, 2000 <br />Well Survey Site Address l j b 4�L, ! <br />Yes No <br />0ff <br />A water well is present on the property <br />Domestic/Dnnking water well <br />Agricultural/Landscape water well <br />0 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 �� 1 f L ` <br />Signature <br />Date '? <br />