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WATER SUPPLY WELL LOCATION SURVEY FORM <br /> POZO DE AGUA POSICION/ FORMA DE ENTREVISTA <br />' SECOR International <br /> 3475 West Shaw Ave, Suite 104 <br /> Fresno, California <br />' (559)271-2654 <br /> October/Octubre 2004 <br />' Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle '25-7D-7 W <br /> City/Cuidad Amnno. C <br />' State/Estado,Zip Code/Codigo Postal Q5-2ub <br /> Y s/ i No <br /> A water well is present on the property?/Un pozo de aqua estli presente sobre la <br /> caracteristiea(propledad) <br /> 1 Domestic/Drtak ng water well/Pozo de agua Domushco/potable <br /> Agncultural/Landscape water well/Pozo de Agua agricola/paisale <br /> Ye0i No <br />' Is the well being used?/LPozo el `? <br /> es usado <br /> Z�ov�-P—Iease provide well construction details/Si conoczdo,por favor summistre pozo detalles de <br /> construcci6n <br /> Date installed/Fecha mstalada <br />' Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br /> Casing diameter/Ditmetro de cubierta <br />' Screen Ynterval/Intervalo de pantalla <br /> _ Survey completed by/Revisibn completada por <br /> Name/Nombre S hanie Furg al of SECOR for homeowner/business owner <br /> Signature/Firma <br /> Date/Fecha 6glbq <br /> r <br />