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PWS ID / FACILITY ID <br />1020035 S05 <br />UNIQUE WELL NO. <br />580313 <br />SETBACK DISTANCES <br />All potential contaminant sources must be noted on sketch. <br />Record the distance and approximate compass bearing of each potential contaminant source from the well, <br />and identify the source using the "Source Code". Unlabeled points on the map are unsealed wells. <br />270° <br />315° <br />• <br />0° <br />99 <br />9 <br />45° <br />99 <br />90° <br />Alli.D1 <br />SB2 <br />w <br />225° <br />`\ ON <br />F" <br />• <br />,t• <br />• <br />• <br />135° <br />• <br />180° <br />Y <br />N <br />N/A <br />Were the isolation distances maintained for the new sources of contamination? <br />X <br />Is the system monitoring existing nonconforming sources of contamination? <br />X <br />Reminder Question: Were the wellhead protection measure(s) implemented? <br />INSPECTOR <br />Freitag, John <br />DATE <br />6 - 12 - 2019 <br />6/21/2019 <br />4 <br />