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1 <br /> 1 <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 /> StreetlCalle <br />' City/Cuidad D C <br /> State/Estado,Zip Code/C6digo Postal `'GS�i�il7 <br /> Ye /S No <br /> A water well is present on the property?/Un pozo de agua este presente sobre la <br />' caracteristica(propiedad) 9 <br /> Domestic/Drinlang water well/Pozo de agua Dom6stico/potable <br /> 1 <br /> Agricultural/Landscape water well./Pozo de Agua agricola/paisaje <br /> Unknown/Desconocido <br />' Yesl No <br /> Is the well being used?/LPozo e1 es usado? <br /> own,please provide well construction details/Si conocido,por favor suministre 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/Dlfimetro de cubierta <br /> Screen mterval/intervalo de pantalla <br />' Survey completed by/Revisi6n completada por - – - <br /> Name/Nombre Sj2phanie Furgal of SECOR for homeowner/business owner <br /> 1e�—x L <br /> Signature/Firma- <br />' Date/Fecha [ bq <br /> I <br />