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WATER SYSTEM INVENTORY REPORT <br />DATE: <br />NAME OF SYSTEM: <br />ADDRESS OF SYSTEM: <br />PEOPLE TO CONTACT IN CASE OF AN EMERGENCY: <br />addressthtyWNE1T5 REPRE^NTATTVF' <br />TeLTPHORTTAY/ NIGHT <br />(Total Number of Service Connections)Z ssws NCWS,sews CLASSIFICATION: <br />MARINA TRAILER PARK RESORT FACILITIES SERVED:SCHOOL <br />RESIDENCES LABOR CAMP MARKET GAS STATION <br />OTHER APARTMENTS INDUSTRY <br />NO-7 YES SANITARY WELL SEAL PROPERDEPTHDEPTH <br />/ZHiXNO HEIGHT OF CASING ABOVE GRADEYESPEDESTAL PRESENT: <br /> JET ^TURBINE CENTRIFUGALSUBMERSIBLEPUMP: <br />NO YES IS DISINFECTION PROVIDED: <br />IF SOURCE IS SURFACE WATER, COMPLETE FOLLOWING: <br />NOPRETREATMENT (INCLUDES ADDITION OF POLYMER, ROUGHING FILTER):YES <br />OTHER CHARCOAL DIATOMACEOUS EARTH FILTER TYPE:SAND <br />GALLONSSTORAGE TANK SIZE: <br />BOTHPOST CHLORINATION:PRE <br />NO YES TEST KITS PROVIDED: <br />NO YES CERTIFIED PLANT OPERATOR: <br />NO YES ATTACH APPROVED PLAN FOR SYSTEM: <br />400Rev. 2/82EH 14 31 <br />(WCTT) <br />IF SOURCE IS WELL, COMPLETE FOLLOWING: <br />OF ANNULAR SEAL Z <br />Z-Y' O'! ; <br /> 1^6, fay*. 9Fi? JZkn <br />—-scDRrsszcTrY <br />RESTAURANT _