Report of Well Problem英文资料.pdfVIP

September 17, 2015 Report of Well Problem Report of Well Problem Stanislaus County Department of Environmental Resources 3800 Cornucopia Way, Suite C Modesto, CA 95358 209-525-6700 Purpose: As part of our effort to assess drought impacts, we would like to document specific wells that may be experiencing problems. Although we cannot solve individual well problems, information we gather will assist in our drought assessment efforts. Please help provide this information by reporting any problems you experience with your well. Given the sensitive nature of private well information, we will not publicize information about specific wells. Thank you for your voluntary participation. 1. First and Last Name: 2. Phone Number: 3. Email Address: 4. Address of well location: 5. Latitude and Longitude: Using Google Earth or Google Maps, copy and paste the approximate location of the well. Specific well locations will not be made public. 6. What is the primary use of the well? Check only one box Domestic (household use) Ag Irrigation Supply Combination of Domestic and Ag Use 1/4 September 17, 2015 Report of Well Problem Other: 7. What is the problem? Check only one box Well is catching air; need to wait to be able to pump Well is no longer producing water Reduction in water pressure Other: 8. When did the pro