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WATER SUPPLY WELL LOCATION SURVEY FORM <br />SECOR International <br />3017 Kilgore Road, Suite 100 <br />Rancho Cordova California <br />(916) 861-0400 <br />May 10, 2000 <br />Well Survey Site Address <br />Yes No <br />0 1,\�j A water well is present on the property <br />Domestic/Dnnking water well <br />0 Agricultural/Landscape water well <br />Q Unknown <br />Yes No <br />CIs the well being used I <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 b <br />Name <br />Signature <br />Date <br />0 <br />