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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) 271-2650 <br /> October 1 Octubre 2004 <br /> Well Survey Site Address/Pozo de Sitio d`eEntrevista c <br />' Street/Calle � <br /> City/Cuidad D C <br />' State/Estado,Zip Code/C6digo Postal 52 <br /> YesiSi No <br /> Nn L—J A water well is present on the property?/Un pozo de aqua estA presente sobre la <br /> caracteristica(propiedad)? <br /> Domestic/Drmkmg water well/Pozo de agua Dom6stico/potable <br /> AgrnculturalALandscape water well./Pozo de Agua agricola/paisale <br />' Unknown/Desconocido <br /> YetJS1 No <br />' a is the well being used?/LPozo el es usado? <br /> Nknown,please provide well construction details/Si conocido,por favor summistre pozo detalles de <br /> construcci6n <br /> Date mstalled/Fecha mstalada <br />' Depth of well/Profundidad de Pozo <br /> Casmg Type/Tipo de Cubierta <br /> Casing diameter/Di6metro de cubierta <br />' Screen mtervaVintervalo de pantalla <br /> Survey completed by/Revisi6n completada por <br />' Name/Nombre Stephanie Furgal of SECOR for homeowner/busmess owner <br />' Signature/Firma 44�L <br /> Date/Fecha C6 8 <br /> I <br />