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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 100 <br />Rancho Cordova Cakform►a <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address ;i r- L."C, <br />Yes No <br />[� �-A water well is present on the property <br />Domestic/Drinking water well <br />Agricultural/Landscape water well <br />Q Unknown <br />Yes No <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 ] /'P A' -t l �'d <br />Date r (} <br />