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NOV-05-2002 18 06 CAMBRIA 1707 335 6649 P 83/05 <br /> d <br /> October 28,2002 <br /> Dear Resident <br /> The following is an mdependtmt public health questionnaire to determine if airy basements or rittia Mal, domestic, <br /> or irrigation wells east near the Intersection of Moreland Court and Hama=Lane, Stoclion, California. The Sen <br /> Joaqum County Public Health Services (SJCPHS)is requesting that we identify these features in the area as part of <br /> an ongomg environmental investigation. <br /> Please fill out the following information to flit best of your Imowledge If you do not /mow, Just marls it <br /> "UNKNOWN` Even if there is no well or basement at the address listed,please complete item 1 and return the <br /> survey Should you have any questions, please contact the Cambria Envirotunental Technology, Inc project <br /> manager listed below or Harlin Knoll at the SJCPHS at(209)468-3442 This information can be subrmtted by mail, <br /> by facsumle or verbally by phone. Thank you for your cooperation. <br /> CAMBRIA ENVIRONMENTAL TECIINOLOGY,INC <br /> Aubrey Cool <br /> Project Manager <br /> Phone (510)420-3336 Fax (510)420-9170 <br /> P 0 Boa 259 <br /> Sonoma,Califomia 95476 <br /> j (1) PROPERTY ADDRESS e^ e;:fel 1.S a� I<d�� CA <br /> D <br /> OWNER NAME. �rQf.�F 'n-k n.c <br /> �- DAYTIME PHONE <br /> TENANT NAME (if not owner) _ DAYTIME PHONE <br /> (2)Are there any wells at the address listed en item 1 (circle one) <br /> YES UNKNOWN NO ! <br /> (3)Are there any wells in the vicinity of the address listed m item 1 (c)rcle one) <br /> YES UNKNOWN NO gyre t.,C�1 S <br /> (4)Are there any abandoned wells at she address listed in stern 1 (circle one) YES UNKNOWN NO <br /> Comments <br /> S ...._._.__ _,.... .,.....,,. _ - — <br /> ( )Arc there any bawmcnts at the address listed in item 1 (circle one) YES UNKNOW <br /> NKNO NONO <br /> (6)is the residence at the address listed in stem I on city water (circle one) YES NO <br /> if you answered"YES"to 2 or 3 above,please provide the following details,if possible. If there is more than one well,please <br /> indicate which well you are descnbirig. <br /> WELL ADDRESS WELL OWNER <br /> WELL WATER USE 9Z:%/i e,- FREQIJENCY OF USE <br /> WELL DIAMETER, f-A-i.�__- WELL DEPTH t/t" ff i <br /> WELL MATERIAL (circle one) PVC plamc steel brioldclay offer 1/urti[e <br /> SCREENED INTERVAL(S)OR PUMP DEPTH <br /> DATE OF INSTALLATION, Lt^ <br /> OTHER INFORMATION! <br />