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i <br /> i <br /> I 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 Soso de Entrevista <br /> Street/Calle -25 6. tri'` I.0 <br /> City/Cuidad 0 QA- <br /> State/Estado,Zip Code/C6digo Postal �2522� <br /> Y,esjS1 No ' <br /> A water well is present on the property?/Un pozo de agua estfi presente sobre la <br /> caracteristica(propiedad) <br /> Domestic/Dnnking water well/Pozo de agua Dom6stico/potable <br /> Agricultural/Landscape water well/Pozo de Agua agricola/paisale <br /> Unknown/Desconocido <br /> Yep/Si No <br /> Is the well being used?/LPozo el es usado? <br /> known,please provide well construction details/Si conocido,por favor sununistre pozo detalles de <br /> construcct6n <br /> Date mstalled/Fecha mstalada <br /> Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br /> Casing diameter/Di6metro de cublerta <br /> Screen mterval/Intervalo de pantalla <br /> Survey completed by/Revisi6n completada por <br /> Name/Nombre Stephanie Furgal of SECOR for homeowner/busmess owner <br /> Signature/Firma 4q� <br /> IDate/Fecha C6 <br />