HomeMy WebLinkAbout028-390-004 EHWS23-0058 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 Clerical/FORMS/Disinfection Statement
Big'N & Son Drilling, Inc. - Elias Medrano
PO BOX 902, Palermo CA 95968 530-403-7611
028-390-004
Paul Sommers
6/30/2023
211 Sunny Hills Road, Bangor 95914