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lie <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 /> r <br /> Well Survey Site Address/Pozo de Sino de Entrevista <br />' Street/Calle 25355 0 99 <br /> City/CuidadQ <br />' State/Estado,Zip Code/C6digo Postal, <br /> Yes/ i No <br /> A water well is present on the property?/Un pozo de agua estiL presente sobre la <br /> • caracteristica(propiedad)'? <br />' Domestic/Drinlang water well/Pozo de ague Dom6stico/potable <br /> Agricultural/Landscape water well/Pozo de Agua agricola/paisale <br /> Y i No <br /> 1MI 0 Is the well being used?/LPozo el es usado9 <br /> known,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 /> Casing Type/Tipo de Cubierta- <br /> Casing diameter/Di6metro de cubierta <br />' Screen mterval/Intervalo de pantalla <br />' Survey completed by/Revisi6n completada por _ <br /> Name/Nombre (lt' <br />' Signature/Fuma CQV <br /> Date/Fecha <br /> D7 <br /> o <br />