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1 <br />' 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) 271-2650 <br /> October/Octubre 2004 <br />' Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle 19-5--1U <br /> City/Cuidad 0 C <br />' State/Estado,Zip Code/Cadigo Postal g5ub <br /> YesiSi No <br /> 1P A water well is present on the property9/Un pozo de agua esth presente sobre is <br /> caracteristica(propiedad)9 <br /> lie Domestic/Dnnlang water well/Pozo de agua Dom6stico/potable <br /> AgnculturaMandscape water well/Pozo de Agua agricola/paisale <br />' Uulanown/Desconocido <br /> e Si No <br />' = Is the well being used?/LPozo el es usado? <br /> If own,please provide well construction details/Si conocido,por favor suministre pozo detalles de <br />' construccibn <br /> Date installed/Fecha mstalada <br />' Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br /> Casing dlameter/Diimetro de cubierta <br />' Screen mterval/Intervalo de pantalla <br /> Survey completed by/Revisi6n completada por <br /> Nam <br /> e/Nombre S haute Furg al of SECOR for hoineowner/busmess owner <br />' Signature/Firma <br /> Date/Fecha (Ao�A t./ <br />