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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/Octubre 2004 <br />' Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle o Q <br />' City/Cuidad D C <br /> State/Estado,Zip Code/C6digo Postal 522 <br /> Yes/ No <br /> A water well present on the property?/Un pozo de agua este presente sobre la <br /> caracte ' ca{propiedad) ? <br /> Domestic/Dnnking water well/Pozo de aqua Dom6stico/potable <br />' <br /> Agri culturald andscape water well/Pozo de Agua agrlcola/paisale <br /> Unknown/Desconocido <br />' Yes/ No <br /> Is the well being used?/yPozo el es usado? <br />' If known,please provide well construction details/Si conocido,por favor suministre pozo detalles de <br /> construcci6n <br />' Date installed/Fecha mstalada <br /> Depth of well/Profundidad de Pozo <br /> Casing TypelTipo de Cubierta <br />' Casing diameter/Dii metro de cubierta <br /> Screen mtervaVIntervalo de pantalla <br />' Survey completed by/Revisi6n completada por <br /> Name/Nombre S home Furgal of SECOR for homeowner/business owner <br />' Signature/Firma <br /> 40' Date/Fecha Cb <br />