HomeMy WebLinkAboutWell_disinf_stmt_hosler_2023Disinfection Instructions: A Chlorine solution is used for well disinfection. Contact the County
Environmental Health Division if there are any questions.
Section 2313-9 of the Code of Butte County requires a completed Statement of Disinfection to be on file
in order for a water well installation to be finaled by this Department.
Assessor Parcel Number
Name of Property Owner
STATEMENT OF DISINFECTION
006-660-035
Address/Location of drilled well
BRANDON GILL
HOSLER AVE
Name of person who performed disinfection
Shane Besser
Mailing Address 4550 Besser Ct. Chico Ca 95973
Signature of person performing disinfection
Date of disinfection
02/2023
#( t 5303430924
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
Clerical7FORMS/Disinfection Statement
Disinfection Instructions: A Chlorine solution is used for well disinfection. Contact the County
Environmental Health Division if there are any questions.
Section 2313-9 of the Code of Butte County requires a completed Statement of Disinfection to be on file
in order for a water well installation to be finaled by this Department.
STATEMENT OF DISINFECTION
Assessor Parcel Number
Name of Property Owner
Address/Location of drilled well
Name of person who performed disinfection
Mailing Address
Signature of person performing disinfection
Date of disinfection
#( i
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
ClericalMORMS/Disinfemion Statement