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SERVICE,,REQUEST <br /> Facility ID — Facility Name ' <br /> Record ID 013644 Location 1120 E. -HAMMER, STKN,, (1210 HMR <br /> eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee <br /> Property Owner SAFEWAY, INC <br /> Business Name 369 PINE ST, #700 SF, 94104 <br /> Street Number Dir Street Name Type Unit <br /> 1120 E HAMMER LN <br /> 2nd Address SAFEWAY PROPERTY DEV-GEN CNSL #9.8-5439 <br /> City 15350 S ,W. SEQUOIA300 State OR Zip 97224- <br /> 1 <br /> Phone 1 415-398-8842 Ext APN 094-030-12 <br /> Phone 2 209-583-5571 Ext <br /> Census 000001 District 002 Location 01 Citycode <br /> Requestor KEN MATIEK, RG FOR HORIZON ENV <br /> Business Name WOODWARD DRILLING, C-57#710079 <br /> Address I PO BOX 336 <br /> Address 2 <br /> City RIO VISTA, State CA Zip <br /> Phone Number 707-374-4300 Ext <br /> Nature of Service Request - <br /> BORING PERMIT FOR OFFSITE MW-2 PLACEMENT UNDER APPROVED WP/LOP <br /> CONCURENT WITH ONSITE MW, VW, AND AIR SPARGE WELL INSTALLS . CHEC <br /> SERVICE REQUEST <br /> eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee.eeeeee <br /> Comments - <br /> #1456 (HORIZON) FOR $178 TO -COVER THIS PERMIT AND SR 013643 ALSO. <br /> SIGNED ACCESS AGREEMENT ON FILE IN LOP FILE FOR 1210 E . HAMMER. <br /> UPDATE (10-04-99) : ENVISION SR DATABASE TO REFLECT EXACT ADDRESS OF WEL <br /> AND CORRECT ADDRESS OF OFFSITE OWNER. <br /> Name Date Time <br /> Received By 0684 INFURNA, MICHAE 09/04/97 <br /> Assigned To 0684 INFURNA, MICHAE 09/12/97 <br /> Date Service Completed 09/25/97 Requires Further Action Y/N N <br /> Amount paid 178 . 00 Program/Element - 3501 <br /> Due date <br /> 0 This record was entered on 09/15/97 By STAFF <br /> 0 This record was last updated on 10/04/99 By STAFF 0 <br /> i. - - - - - - - - - - - - - - - - - - <br />