HomeMy WebLinkAbout063-040-065 EHWS23-0017 Well 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 063-040-065
15184 Siwini Rd, Forest Ranch, 95954
Roger Westman
Big'N & Son Drilling, Inc. - Elias Medrano
PO BOX 902, Palermo, CA 95968 530-403-7611
05/15/2023