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SERVICE RE(:GEST <br /> Facility ID -- Facility Name <br /> Record ID 020848 Location 1210 E .HAMMER, offsite-COS-ROW <br /> Property Owner city of stockton right of way <br /> Business Name PUBLIC WORKS DEPT, JASON ENDER <br /> Street Number Dir Street Name Type Unit <br /> 1210 E HAMMER LN <br /> 2nd Address HORIZON ENVIR, K. MATIEK,RG,ULTRAMAR <br /> City EL DORADO HILLS State CA Zip 95762- <br /> Phone 1 916-939-2170 Ext AFN <br /> Phone 2 559-583-3231 Ext <br /> Census 000001 District 002 Location 01 Citycode <br /> Requestor KENNY MATEIK, RG, HORIZON FOR <br /> Business Name V & W DRILL, C-57 #720904 <br /> Address 1 PO BOX 51 <br /> Address 2 <br /> City RIO VISTA State CA zip 94571- <br /> Phone Number 707-374-2815 Ext <br /> Nature of Service Request - <br /> OFFSITE MONITORING WELL #8 INSTALLATION IN CITY ROW IN HAMMER L <br /> ANE CENTER DIVIDER JUST NORTH OF GAS STATION. COS ENCR #65391 <br /> SERVICE REQUEST <br /> Comments - <br /> AND COS REVOCABLE #99-14 ISSUED AND VALID TO 11-1-99 . THIS SR CONCURRE <br /> NT WITH SR# 020847 FOR MW-6 &7 INSTALL ON SITE WITH SOIL BORING B-3 . <br /> ONE HORIZON CHECK ($178) #4979 FOR BOTH SR' S . WORKPLAN DATED 4-22-99 AP <br /> PROVED BY INFURNA-LOP ON 5-21-99 . <br /> Name Date Time <br /> Received By 0684 INFURNA, MICHAE 10/07/99 <br /> Assigned To 0684 INFURNA, MICHAE 10/14/99 <br /> Date Service Completed Requires Further Action Y/N Y <br /> Amount paid 178 . 00 Program/Element 3501 <br /> Due date <br /> • This record was entered on 10/14/99 By STAFF 0 <br /> • This record was last updated on 10/14/99 By STAFF 0 <br />