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Dear Resident November 5,2001 <br /> The following is an independent public health questionnaire to determine if any basements or municipal, domestic, <br /> or irrigation wells exist in the vicinity of Waterloo Road and Highway 99 in Stockton, California The San Joaquin <br /> County Public Health Services is requesting that we identify these features in the area as part of an ongoing <br /> environmental investigation <br /> Please fill out the following information to the best of your knowledge If you do not know, please answer <br /> "UNKNOWN" Even if there is no well or basement at the address listed, please complete items 1 through 5 and <br /> return the survey in the postage-paid envelope provided at your earliest convenience Should you have any <br /> questions, please contact the Cambria Environmental Technology, Inc prosect manager listed below This <br /> information may be submitted via mail,facsimile,or verbally by telephone Thank you for your cooperation <br /> CAMBRIA ENVIRONMENTAL TECHNOLOGY,INC <br /> Aubrey Cool <br /> Project Geologist <br /> Phone (707)933-2368 Fax (707)935-6649 <br /> P O Box 259 <br /> Sonoma,CaIiforma 95476 <br /> (l) PROPERTY ADDRESS es- paI QQ C nyeno,c,2- 4reA T <br /> OWNER NAME DAYTIME PHONE <br /> TENANT NAME (if not owner) 1,4r LAYTIME PHONE � t�4fC 8-3C" <br /> (2)Are there any wells at the address listed in item 1 (circle one) y <br /> 1� YES UNKNOWN <br /> (3)Are there any wells in the vicinity of the address listed in item 1 (circle one) <br /> (jg) UNKNOWN NO <br /> (4)Are there any abandoned wells at the address listed in ttem 1 (circle one) YES UNKNOWN NO <br /> Comments <br /> (5)Are there any basements at the address listed in item i (circle one) YES UNKNOWN NO <br /> (6)If you answered"YES"to 2 or 3 above,please provide the followingdetails,if possible If there is more than one w <br /> Po well,please <br /> indicate which well you are describing C, AwYA <br /> WELL ADDRESS WELL OWNER S4-7 Cg e, <br /> � `� � - <br /> WELL WATER USE --�c�sY�.a FREQUENCY OF USE_ _nf1� Uyt Y Yvq <br /> WELL DIAMETER WELL DEPTH _ /J1-A k 0c _ <br /> CbLtVI Oi(X <br /> WELL MATERIAL (circle one) PVC plastic steel brick/clay other n� } <br /> SCREENED INTERVAL(S)OR PUMP DEPTH y IAS ' a We I(c <br /> DATE OF INSTALLATION 1 d -Are OL <br /> OTHER INFORMATION S <br /> [ �>f <br /> to <br /> 1359 �e�,l _-�l.l <br /> Ca.�Y,''}h la \&&ACX <br />