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NOV-07-2002 10 16 CAMBRIA 1707 935 6649 P 02/02 <br /> R.FF I V E D <br /> Dear Resident: NOV O 7 2002 October 28,2002 <br /> The Wowing is asdent lac health <br /> or ungation wells exist a the intersection of Mortland Court ad Hammer La=,Stockton, California. The San <br /> Joaquin County Public Health Services(SJCPHS) is requestW that we identify these features m the area as part of <br /> an ongoing environmental investigation. <br /> Pieria fill out the followmg information to the best of your imowledge. If you do not Brow, just mark it <br /> "UNKNOWN" Even if there is no well or baseaxnt at the address listed,please complete item 1 and retina the <br /> survey Should you have any questions, please contact the Cambria Environmental Technology, Im- project <br /> ni ager lasted below or Harlm Knoll at the SJCPHS at(209)468-3442, This information can be suboutted by marl, <br /> by gwsurnle or verlaUy by phone. Think you for your cooperation. <br /> CAMBRIA ENVIRONMENTAL TECHNOLOGY,INC <br /> Aubrey Cool <br /> Project Manager <br /> Phone (510)420-3336 Fax (510)420-9170 <br /> P O Box 259 <br /> Souama,Californta 95476 <br /> i <br /> (1) PROPmTY A.DDREss- 7 g a 64nj s5l&e e, � G� <br /> DWNL7R NAME1 .G ]� DAYTIME PHONE <br /> TENANT NAME (if not owner) DAYTIME PHONE <br /> (2)Are there any wells at the address lasted in stern 1 (circle one) <br /> [. CNOWN NO <br /> (3)Are them any wells in the vicinity of the addrew listed in item 1 (cacle one) <br /> YES UNKNOWN NO <br /> (4)Arc them any abandoned wells at the address listed in item 1 (cncle one) YES UNKNOWN NO <br /> CorrzQients. <br /> (5)Are there any basements at the address listed in item 1:(circle one) YES UMWOWN NO <br /> (6)Is the residence at the address listed in item 1 on city water(cucle one) YES <br /> If you answered"YES"to 2 or 3 above,please provide the following derails,if possible.If there is snore than one well,please <br /> indicate which well you are desmbing- <br /> WELT.ADnREsS• :7q8D M0Q!,14KA WELL OWNER <br /> WELL WATER UST; G FREQUENCY OF USE <br /> WELL DIAMETER t` WELT,DM—M <br /> WELL MATERIAL-(circle one) PVC plastic bricWclay othor <br /> SCREENED INTERVAL(S)OR PUMP DB7111 1 O <br /> DATE OF INSTALLATION 92& <br /> OTHER INFORMATION <br /> 4 I 1 I <br /> TOTAL P 02 <br />