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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 900 <br />Rancho Cordova Califomia <br />(916) 869-0400 <br />May 10, 2000 <br />Well Surrey Site Address l6c-� r ��fi r LSC, -,e <br />Yes No <br />0 F��j <br />A water well is present on the property <br />0 DomesticlDrinking water well <br />Agricultural/Landscape water well <br />Q 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 Kn&(�o O <br />Signature 'Lz;y , ��E- - <br />Date �-/ Z <br />c: <br />