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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017101gore Road, Suite 900 <br />Rancho Cordova Cahfomia <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address I bD �- - --- <br />Yes No <br />0 [YA water well is present on the property <br />Domestic/Drinking water well <br />Q Agricultural/Landscape water well <br />Q Unknown <br />Yes No <br />0EZ 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 />NameH - <br />Signature Vjox/z/ E z4zzk'l� <br />1 <br />Date <br />is <br />