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PWS ID / FACILITY ID <br />1020035 SO1 <br />UNIQUE WELL NO. <br />I 161441 <br />SETBACK DISTANCES <br />IAll 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 />0° <br />180° <br />Were the isolation distances maintained for the new sources of contamination? <br />Is the system monitoring existing nonconforming sources of contamination? <br />90° <br />Y N N/A <br />X <br />X <br />Reminder Question: Were the wellhead protection measure(s) implemented? <br />INSPECTOR <br />6/21/2019 <br />Freitag, John <br />4 <br />I DATE 16 - 12 - 2019 <br />