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WATER SUPPLY WELL LOCATION SURVEY FORM <br /> POZO DE AQUA POSICION/FORMA DE ENTREVISTA <br /> SECOR International <br /> 3475 West Shaw Ave, Suite 104 <br /> Fresno, California <br /> (559)271-2650 <br /> EOctober/Octubre 2004 <br /> Well Survey Site Address/Pozo de Salo de Entrevista <br /> Street/Calle � 144 Zke <br />' Crty/Cuidad fidlatb'P4 <br /> OIL <br /> State/Estado, Zip Code/Cddigo Postal, qJ5 Z0 <br /> es/ x No <br /> E�F F-1 A water well is present on the property`s/Un pozo de agua esti presente sobre la <br /> I. caracteristxca(propiedad) <br /> Domestic/Drinkmg water well/Pozo de agua Domestico/potable <br /> Agricultural/Landscape water well/Pozo de Agua agricola/paisale <br />' es/ <br /> Is the well being used?ILPozo el es usado9 <br /> Jown,please provide well construction details/Si conocido,por favor suministre pozo detalles de <br />' construccibn <br />' Date mstalled/Fecha instalada. <br /> Depth of well/Profundidad de Pozo <br /> Casmg Type/Txpo de Cubierta <br />' Casing diameter/Dittmetro de cubierta <br /> Screen mterval/intervalo de pantalla <br />' Survey completed by/Revisihn completada Por <br /> Name/Nombre S hanie Furgal of SECOR for homeowner/busmess owner <br />' Signature/Firma <br /> i -4qT -e, (2 <br />' Date/Fecha �6glbq <br /> 1 <br />