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To. Whom it May Concern <br /> Date: 14 Apn 12017 <br /> Page 2 <br /> LOVELAND READY-MIX CONCRETE and TELESTO SOLUTIONS <br /> QUESTIONNAIRE FOR WELL WATER <br /> 1. Please confirm the following information so that we can contact you: <br /> Name 01.k L C e2 /_A-i!!Z-660 `r <br /> Mailing Address P 0. B © x Ff! <br /> Street Address 0 '�-1 O G 4 x- <br /> City, State, Zip Code <br /> Best Phone Number to Contact You ,ZIZ !466 3 <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. Inactive (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 <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 /> You may return this form in the enclosed stamped envelope or email it to: <br /> pcoit(a-jelesto-inc.com <br /> 20170414_cr ow,<<„ore,Well&rr vey T E LE S T O <br />