HomeMy WebLinkAbout021-132-056 EHWS24-0062 WELL DISNFCTN STMNTDisinfection 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 U — 3 2 _(-) S co
Name of Property Owner Z-L U�,2
Address/Location of drilled well 1 ZO / ZI Z- FiL,c L /, �� U
Name of person who performed disinfection S L jq
Mailing Address 30()(o 7-)�/t,�� Phone # (Svi /3 ""5 s U
Signature of person performing disinfection
Date of disinfection I i fS�Zy
Please return this Statement of Disinfection to: Butte County Environmental Health Division
202 Mira Loma Drive
Oroville, CA 95965
Clerical/FORMS/Disinfection Statement