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WATER SYSTEM INVENTORY REPORT <br />DATE: *7-72- <br />NAME OF SYSTEM: <br />r/7ADDRESS OF SYSTEM: <br /> <br />AD'DRESSZCTTvOWNER'S REPRESENTATIVE' <br />TeTEPHORTWN IGHT <br />(Total Number of Service Connections)SSWS NCWS sews CLASSIFICATION: <br />MARINA TRAILER PARKRESORT FACILITIES SERVED:SCHOOL <br />RESTAURANT RESIDENCES LABOR CAMP MARKET GAS STATION <br />OTHER APARTMENTS INDUSTRY <br />YESSANITARY WELL SEAL PROPER <br />HEIGHT OF CASING ABOVE GRADE NO PEDESTAL PRESENT:YES <br />SUBMERSIBLE TURBINE JET CENTRIFUGAL PUMP: <br />NO YES IS DISINFECTION PROVIDED: <br />COMPLETE FOLLOWING: <br /> NOPRETREATMENT (INCLUDES ADDITION OF POLYMER, ROUGHING FILTER):YES <br />OTHER CHARCOAL DIATOMACEOUS EARTH FILTER TYPE:SAND <br />GALLONSSTORAGE TANK SIZE: <br />BOTH POST CHLORINATION:PRE <br />NO TEST KITS PROVIDED:YES <br />NO YES CERTIFIED PLANT OPERATOR: <br />NO YES ATTACH APPROVED PLAN FOR SYSTEM: <br />400Rev. 2/82EH 14 31 <br />A. __Z> <br />^37 <br />““nrffPWE DAY/NIGHT <br />IF SOURCE IS WELL, COMPLETE FOLLOWING: <br />DEPTH DEPTH OF ANNULAR SEAL ' <br />A ) <br />PEOPLE TO CONTACT IN CASE OF AN EMERGENCY: <br />VPulldVl <br />(OWNER) <br />A? <br />—ATOEs<7nTT~/ <br />IF SOURCE IS SURFACE WATER, <br />NO