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2. Report of Well Problems

   Colusa County Sheriff's Office, Emergency Services
   530-458-0218 | email: jbell@countyofcolusa.com

4. Purpose: The Colusa County Emergency Services Division is asking landowners to report all well issues, whether drought-related or mechanical. This information will help in our efforts to gain a better understanding of the groundwater system. Please answer as many of the questions on this form as you can, and submit the form to the Colusa County Emergency Services Division. Specific well locations will not be made public. Thank you for your voluntary participation.

6. Date:
   Date:

   Date:
8. First Name*
9. Last Name*
11. Address1
13. Address2
15. City
16. State
17. Zip
19. Phone:
21. Email:
23. WELL LOCATION

    Please provide any or all of the following information about the location of your well. Well locations will not be made public.

25. APN Number
27. Address
29. Cross Streets
30. Latitude and Longitude
32. Section, Township, Range
34. General Area*
36. WELL INFORMATION

    Please provide any or all of the following information.

38. Type of Well (irrigation, domestic, etc.)*
39. Size and type of casing
41. Age of Well
42. Depth of well
43. Depth to water
45. Gallons per minute
46. Percent change in gallons per minute
48. Date measured
49. Were these static measurements?
    -- Select One --YesNo
51. Please describe the problem with the well*
53. Has the well been inspected by a qualified well inspection professional since the problem started?*
    -- Select One --YesNo
55. If the well has been inspected, what was determined to be the cause of the well problem?
57. Has the problem been fixed (yes or no) and if yes, how?*
59. Is there anything else we should know?
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field