HomeMy WebLinkAbout033-010-068 EHWS23-0079 Disinfection StatementDisinfection 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 --------------------Name of Property Owner ___________________ _ Address/Location of drilled well -----------------------Name of person who performed disinfection __________________ _ Mailing Address __________________ Phone# ( ) ____ _Signature of person performing disinfection __________________ _ Date of disinfection _______ _ Please return this Statement of Disinfection to: Butte County Environmental Health Division 202 Mira Loma Drive Oroville, CA 95965 033-010-068
Elias Medrano
PO BOX 902, Palermo CA 95968 530-403-7611
9/8/2023
0 Bo-Y-Le Lane, Oroville CA 95966
Jose Madriz