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NOV-05-2002 18 07 CAMBRIR 1707 935 6649 P 04/05 <br /> r, <br /> • October 28,2002 <br /> Dear Resident <br /> The following is an independent public health questionnaire to determine if any basements or wunicipal, domestic, <br /> or irrigation wells exist near the mtcrsection of Moreland Court and Harnnner Lane, Stockton, California The San <br /> Joaquin County Public Health Services(SJCPHS)is requesting that we identify these features in the area as part of <br /> an ongoing environmental investigation. <br /> Please fill out the following inforzriation to the best of your knowledge If you do not ]mow, ;list mark it <br /> "UNKNOWN" Even if there is no we11 or basement at the address listed, please complete item 1 and return the <br /> survey Should you have any questions, please contact the Cambria Envira mental Tecbnology, Inc project <br /> manager listed below or Harlin Knoll at the SJCPHS at(209)468-3442 'finis information can be submitted by mail, <br /> by facsuiule or verbally by phone 'dank you for your cooperation <br /> CAMBRLA ENVIRONMENTAL TECHNOLOGY,INC <br /> Aubrey Cool <br /> Project Manager <br /> Phone (510)420-3336 Fax (510)420-9170 <br /> P O Box 259 <br /> Sonoma,Cahfornia 95476 <br /> (t) PROPERTY ADDRESS ll S�o NG`tl n <br /> OWNER NAME DAYTIME PHONE <br /> TENANT NAME (if not owner) DAYTIME PHONE <br /> (2)Are there arty wells atz7r <br /> in item 1 (circle one) <br /> UNKNOWN NO <br /> (3)Are there any wells in the v, of the address listed in item I (circle one) <br /> UNKNOWN NO <br /> (4)Arun there any abandoned wells at the address listed in item I (circle one) YES UNKNOWN <br /> Conmtents: <br /> (5)Arc there any basements at the address listed in item I (circle one) YES UNKNOWN NO <br /> (6)Is the residence at the address listed in item I on city water(oircic one) YES NO <br /> If you imswend,"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 describing. <br /> WELL ADDRESS —7 G) /A�- 1 -„ - -- WELL OWNER <br /> WELL WATER USE- jQ aa,.�44�`G REQUENCY pF U5E ,��i t/�, <br /> WELL DIAMETER l WELL DEPTH IDD <br /> WELL MATERIAL.(circle one) PVC plastic steel bncidday other <br /> SCREENED INTERVALS)OR PUMP DEPTH, <br /> . DATE OF INSTALLATION _ Ll <br /> OTHER INFORMATION <br />� E <br /> 0953 <br /> i <br />