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I <br /> 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 /> Strect/Calle x7557 D <br />' City/Cuidad <br /> State/Estado,Zip Code/Cbdigo Postal .L <br /> )(es/pi No <br /> A water well is present on the property?/Un pozo de agua estA presente sobre Ia <br />' caracteristica(propnedad) ? <br /> Domestic/Drinking water well/Pozo de agua Domestico/potable <br />' Agricultural/Landscape water well/Pozo de Agua agricola/pansale <br />' es/ n No <br /> [�F [__j Is the well being used?/LPozo el es usado? <br />' if known,please provide well construction details/Si conocido,por favor summistre pozo detalles de <br /> construcc16n <br />' Date mstalled/Fecha mstalada <br /> Depth of well/Profundidad de Pozo <br /> Casing Type/Tnpo de Cubnerta <br />' Casing dlaIneter/Dltinnetro de cubierta <br /> Screen mtervalllntervalo de pantalla <br />' Survey completed b—y/Revnsibn cdmpletada por <br /> Name/Nombre SQj <br /> Signature/Firma <br />' Date/Fecha 2 <br />