HomeMy WebLinkAbout064-610-040 EHWS22-0048 WELL DISINFCTN STMNTDisinfection Instructions: A Chlorine solution is used for well disinfection. Contact the County
Environmental Health Division if there are any questions.
Section 23B-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 o u, -1. 10. , rn - Oy O
Name of Property Owner
Address/Location of drilled well 0 1ctigj cr,
Name of person who performed disinfection.r je,lq,ev
Mailing Address Cpz z��Euf Y.,rL �„ P .h -to,-1 73 Phone # (S3� -S
Signature of person performing disinfection 1�JS
Date of disinfection
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
Clerical/FORMS/Disinfection Statement