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I <br />' WATER SUPPLY WELL LOCATION SURVEY FORM <br /> F' 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. EulA <br />' City/Cuzdad y6oQA- <br /> State/Estado,Zip Code/CMigo Postal 5.7, <br /> VejVSi No <br /> A water well is present on the property?/Un pozo de agua esth presente sabre la <br />'• caracteristcca(propiedad)? <br /> Domestic/Dnnkmg water well/Pozo de agua Domestico/potable <br /> Agricultural/Landscape water well/Pozo de Agua agricola/paisale <br /> u lwkk4rx---� ( 1oq4p-�- <br />' Yes/ i 0 <br /> Is the well being used?/LPozo el es usado7 <br /> If known,please provide well construction details/Si conocido,por favor sumimstre pozo detalles de <br />' construcci6n <br />' Date mstalled/Fecha smstalada <br /> Depth of well/Profundidad de Pozo <br /> Casing Typenipo de Cubierta <br />' Casmg diameter/Di6metro de cubierta <br /> Screen mterval/Intervalo de pantalla <br />' Survey completed by/Revisi6n completada por <br /> Name/Nombre S hanie Furgal of SECOR for homeowner/business owner <br />' Signature/Fir ma. <br /> 44TLL-c <br />' DateJFecha C6 <br />