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1 <br /> 1 <br />! 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 />' October/Octubre 2004 <br />' Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle 31-( j C rory <br />' City/CuidadAoAri, O C <br /> State/Estado,Zip Code/Cbdigo Postal <br /> i No <br /> 0 A water well is present on the property9/Un pozo de agua esti presente sobre la <br />' caracteristica(propiedad) ? <br /> Domestic/Drinlang water well/Pozo de ague Domestico/potable <br />' Agricultural/Landscape water well/Pozo de Agua agrlcola/paisaje <br /> Unknown/Desconocido <br />' / i No <br /> Is the well being used?/1,Pozo e1 es usado9 <br />' If own,please provide well construction details/Si conocido,por favor suininistre pozo detalles de <br /> construccibn <br /> I Date mstalled/Fecha instalada <br /> Depth of welf/Profundidad de Pozo <br /> Casing Type/Tipo de Cubierta <br />' Casing diameter/Difimetro de cubterta <br /> Screen interval/lntervalo de pantalla <br /> Survey completed by/Revisi6n completada por <br /> Name/Nombre S hanie Furgal of SECOR for homeowner/business owner <br /> ISignature/Firma <br /> i - <br /> Date/Fecha t b <br />