HomeMy WebLinkAboutcentervilledis well final log and disinfection statementDisinfection 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 0 LQ I y o - (� �a
Name of Property Owner F+.1 ". i
Address/Location of drilled well a O Ci ��2 �� A. �\ c e C'
Name of person who performed disinfection 0 inns,
Mailing Address � Hj,,ctg ��', �p G� 9.0d1 Phone#g�b S 1-�
Signature of person performing disinfection,��i„n/ (�
Date of disinfection E-1 0 - �,
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
Clerical/FORMS/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 - ' LI
Name of Property Owner i E L L t
Address/Location of drilled well Q_0 q C Q,nlf,P �� e, rs) L ro
Name of person who performed disinfection Adt i' lLd i,[,
Mailing Address A
Signature of person performing disinfection
Date of disinfection 9-A l- a 3
Phone # pc)) -,
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
Ckricat(FORMS/Disinfcction Statement