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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 700 <br />Rancho Cordova California <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address f L! L L. C , 1„ <br />Yes No <br />0 A water well is present on the property <br />Q DomesticlDrinking water well <br />0 Agricultural/Landscape water well <br />Q Unknown <br />Yes No <br />0 I �_A 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 r� <br />Name ��� G ! <br />Signature <br />Date S — /a _v <br />