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I <br /> i <br /> WATER SUPPLY WELL LOCATION SURVEY FORM <br /> POZO DE AGUA POSICION/FORMA DE ENTREVYSTA <br />' SECOR International <br /> 3475 West Shaw Ave, Suite 104 <br />' Fresno, California <br /> (559)271-2650 <br />' October/Octubre 2004 <br /> i <br />' Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle.'255 ; k tAJ <br />' City/Cuidad p <br /> State/Estado,Zip Code/C6digo Postal C1522t> <br /> Si No <br /> A water well is present on the property?/Un pozo de aqua esti presente sobre la <br /> caracterlstica(propiedad)? <br /> Domestic/Drinking water well/Pozo de agua Dom6stico/potable <br />' Agncultural/Landscape water well/Pozo de Agua agricola/paisale <br />' YWSi No <br /> 'rp " Is the well being used?/LPozo el es usado? <br />' If known,please provide well construction detads/Si conocido,por favor summistre pozo detalles de <br /> construcci6n <br />' Date mstalled/Fecha instalada <br /> Depth of well/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br />' Casing diameter/DJunetro de cublerta <br /> Screen interval/Intervalo de pantalla <br />' Survey completed by/Revisi6n completada par' <br /> Name/Nombre S hanre Furgal of SECOR for homeowner/business owner <br />' Signature/Firma <br />' Date/Fecha l6 <br /> 1 <br />