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f Well Data Sheet Instructions(Rev. 11/99) Page z Information that cannot be found readily should be left blank or entered as"unknown". Fields that are not applicable to a particular well may be entered as"N.A." The third column of the WDS, labeled"Actual, Estimated or Default"should be completed as appropriate. The water system is expected to complete the WDS for new wells as part of the permit application. Guidance on Completing S ecific Fields in the Well Data Sheet DATA SHEET GENERAL INFORMATION System Name: Should match DHS records. System Number: Should match DHS records. Source of information: List the sources used to complete the form such as: DHS or County files, water system staff,well log, DWR records, etc. Organization collecting List the party that collected the information in this form,such as: information: DHS, County, Water System, consultant, or other party,such as a i public agency. Date information collected/updated Enter the date in Month/Year that the information in this form was originally collected or was updated. WELL IDENTIFICATION Well Number or Name: Should match the source—name in DHS records. DHS Source Identification This should be the FRDS ID Number,which is used for federal I Number: reporting. The FRDS ID is the seven-digit system number followed by a dash and a three-digit number(example:4910011-001). The FRDS ID is available from DHS. If you do not know the FRDS ID, the PS Code may be used(this is the identification number used by water systems and laboratories submitting water quality data). If a FRDS ID or PS CODE has not yet been assigned for this source leave the field blank. State Well Number: This number is issued by DWR, and by some local agencies. For some sources,the state well number is the same as the PS Code. If the state well number is known,enter it in this field_ Otherwise DHS will be working with DWR later to identify state well numbers for all public water system wells. Well Status: Should match DHS records for:active, standby or inactive. WELL LOCATION Latitude: The WDS is not intended to be used to submit source location information. Eventually this information will be inserted from DHS records_ For now, it would be better to leave this field blank to avoid confusion. Longitude: See Latitude. Ground surface elevation: Enter as feet above Mean Sea Level (MSL), if known. Street address: Enter the address of the site where the well is located (not the water system address.) If the address number isn't known, enter only the street name. Nearest cross street: Enter the name of the nearest cross street. City Enter the city in which the source is located. If the source is located outside city limits, enter the city that would be used for the mailing address in this area. County Enter the county in which the source is located.