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I o- Whom It May Concern <br /> Date: 14 April 2017 <br /> Pace 2 <br /> LOVELAND READY-MIX CONCRETE and TELESTO SOLUTIONS <br /> QUESTIONNAIRE FOR WELL WATER <br /> 1. Please confirm e following information so that we can contact you: <br /> Name � <br /> Mailing Address L <br /> Street Address <br /> City, State, Zip Code <br /> Best Phone Number to Contact You �O Syr <br /> 2. Please provide the physical location of your well near LaPorte: <br /> Street or Rural Address _ <br /> 3. Is your well (please circle only one): <br /> a. Active (currently in use?) <br /> b. 4nactive (not currently in use, but could be easily used)? <br /> C. Abandoned(damaged or otherwise unusable)? <br /> 4. Would you allow someone to measure depth to water in your well? <br /> (Circle yes or no). <br /> a. Yes b. No / V/ <br /> 5. Any additional information that you can provide concerning your well (e.g. <br /> pumping rate, does it go dry during the winter, how do you use it) would help: <br /> G <br /> You may return this fonn in the enclosed stamped envelope or email it to: <br /> pcoit(u,telesto-tnc.com <br /> 10170414_G)roundit,aler6vellSuri,e>' T E L E ST C <br />