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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)271-2550 <br /> October/Octubre 2004 <br /> Well Survey Site Address/Pozo de Sitio de Entrev►sta <br /> Street/Calle 2 5533 <br /> City/Cuidad 0 C <br /> State/Estado,Zip Code/Codigo Postal "GS�i?il7 <br /> Ypst& No <br /> A water well is present on the property9/Un pozo de agua estit presente sobre la <br /> caracteristica(propiedad)9 <br /> lie Domestic/Dnnl ing water well/Pozo de agua Dom6stico/potable <br /> AgnculturallLandscape water well/Pozo de Agua agricola/paisale <br />' Ir<0Lu6i-y1a I W fur e <br /> Yes/Sz No <br />' 1P = Is the well being used?/LPozo el es usado? <br /> If lamown,please provide well construction detads/Si conocido,por favor summistre pozo detalles de <br />' construcci5n <br /> Date mstalled/Fecha instalada <br />' Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cublerta <br /> Casmg diameter/Ditmetro de cubxerta <br />' Screen mterval/Intervalo de pantalla <br /> Survey completed by/RevisiGn completada por <br />' Name/Nombre Stephanie Furgal of SECOR for horneowner/busmess owner <br />' Signature/Firma <br /> • 6 <br /> Date/Fecha [ <br />