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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 1 Octubre 2004 <br /> Well Survey Site Address/Pozo de Sitio de Entrevista <br /> Street/Calle �a5 Zq 5 v! <br /> City/Cuidad 0 C <br /> State/Estado,Zip Code/Cddigo Postal 52Z� <br /> es/ i No <br /> A water well is present on the propertyl/Un pozo de agua est6 presente sabre la <br /> care teristica(propiedad) <br /> Domestic/Drinlung water well/Pozo de agua Dom6stico/potable <br /> Agricultural/Landscape water well/Pozo de Agua agricola/paisaae <br /> Unknown/Desconocido <br /> Ye S <br /> 0 <br /> Is the well being used?/LPozo el es usado� <br /> Ye <br /> please provide well construction details/Si conocido,por favor suministre pozo detalles de <br /> construction. <br /> 1 Date mstalled/Fecha mstalada <br /> Depth of well/Prof indidad de Pozo <br /> Casing Type/Tipo de Cubierta <br /> Casing diameter/Di6metro de cubierta <br /> Screen uiterval/lntervalo de pantalla <br /> - Survey completed by/Revisidn completada por• - ---- <br /> Name/Nombre. S hanie Furgal of SECOR for homeowner/busmess owner <br /> Signature/Firma <br /> IDate/Fecha [ <br />