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NOV-05-2002 18 06 CRMBRIR 1707 935 5649 P 02/05 <br /> October 28,2002 <br /> DearResident- <br /> The followtmtg ss an independent public health queshonmire,to deterrinme if any basements or ammcipal, domestic, <br /> or irrigation wells exist near the intersection of Moreland Court and Flw mer Lane, Stockton,California The San <br /> Joaquin County Pubhc Health Services(SJCPHS)is requesting that we identify these features m the area as part of <br /> an ongoing emnrotal investigation. <br /> Please fill out the following iWformation to the best of your knowledge If you do not know, lust mark it <br /> "UNKNOWN". Even if there is no well or basement at the address listed, please complete stem 1 and return the <br /> survey Should you have any questions, please contact the Cau tna Envirormnental Technology, Inc project <br /> manager listed below or Harlin Knoll at the SJCPHS at(209)468-3442 This information can be subrrutted by mail, <br /> by facsimile or verbally by phone. Thank you for your cooperfion. <br /> CAMBM ENVIRONMENTAL TEOWOLOG'Y,INC. <br /> Asnbrty Cool <br /> Project Manager - <br /> Phone (510)420-3336 Fax (510)420-9170 <br /> P.O.Box 259 <br /> Sonoma,Cahforma 95476 <br /> (1) PROPERTY ADDRESS ..d .ei G�r d�► <br /> OWNER NAME DAYTIME PHONE. <br /> TENANT NAME (if not owner) DAYTIME PHONE <br /> (2)Are there any welts at thelisted to item 1 (circle one) <br /> YES UNKNOWN NO - -- - -- <br /> (3)Are there any wells in the vicinity of the address hstad ii item 1 (circle one) <br /> <9 UNKNOWN NO <br /> (4)Are there any abandoned wells at the addtesc listed in itan 1 (circle one) YES UNKNOWN <br /> Comments. <br /> (5)Are there any basements at the address listed in item l (circle one) YES UNKNOWN NO <br /> (6)is the residence at the address listed in rbcs 1 on city water(cnida one) YES ONO <br /> If you answered-YES"to 2 or 3 above,please provide the following details,if possible If there is more tban one well,please <br /> indicate which well you an describing <br /> WELLADDRESS 7849 9 17,_,Qtbers WELL OWNER. <br /> WELL WATER USE•. ?�� _ FREQUENCY OF USE. DAILY <br /> WELL DIAwnym ?V? WELL DEPIH _121 <br /> WELL MA'TF-IUA.L:,(etrele one) PVC plastic steel brnckIrlay other <br /> SCREENED MTERVAL(S)OR PUMP DEPTH. _' ? <br /> DATE OF INSTALLATION ?7 — <br /> • OTHER INFORMATION _. TOCKI:ON HALL OF RF-c,pRns---- —_, <br /> F E0953 <br />