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Nov 12 02 09: 24a RMERICAN-USA HOMES LLC 209-952-3045 P. 1 <br /> 0 <br /> Dear Resident- October 28,2002 <br /> i <br /> The following is an independent pubha ho$Ith questionnaire to determine if any basements or San <br /> municipal, domestic, <br /> or nmgation wells exist near the intersection of Moreland Court and Hammer Lane, Stockton, e <br /> Joaquin County Public Health Services(SICPHS)is requesting that we identifCalifornia Thy these features In the area as p n <br /> an ongoing environmental investigation <br /> Please fill out the following information to the best of your knowledge If you do not know, must rsnark it <br /> "UNKNOWN'. Even of there is no well or basement at the address listed, please complete item 1 d re <br /> turn the <br /> survey Should you have any questions, please contact the Caman <br /> Cambria Environmental Technologypro <br /> , Iric tect <br /> manager listed below or Harlot Knoll at the SICPHS at(209)468-3442 This infomiatian can be subinitted by marl, <br /> by facsimile or verbally by phone Thank you for your cooperation. <br /> CAMBRIA ENVIRONMENTAL TECHNOLOGY,INC <br /> Aubrey Cool <br /> Protect Manager <br /> Phone (510)420-3336 Fax (510)420-9170 <br /> P O Box 259 <br /> Sonoma,California 95476 <br /> (1) PROPERTY ADDRESS n�L' Z Z S e., Z.r4 w e- <br /> d <br /> OWNER NAME l - DAYTIME PHONE <br /> TENANT NAME (if not owner) Af f r DAYTIME PHONE <br /> (2)Are there any wells at the address listed in item!-&1L1;1 e one <br /> . YES (r`" UNKNOWN NO <br /> (3)Are there any wells in the vicinity of the ad r m rele one) <br /> YES � UNKNOWN NO <br /> (4)Arc there any abandoned wells at the address listed to item I-(circle one) <SODWNO <br /> Comments <br /> (5)Are there any basements at the address Itsted in item 1 (circle one) Y <br /> ESOWN NO <br /> (6)Is the residence at the address listed in item 1 on city water-(circle one) <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 describing <br /> WELL ADDRESS WELL OWNER. <br /> WELL WATER USE FREQUENCY OF USE <br /> WELL DIAMETER WELL DMvM <br /> WELL MATERLAL (circle one) PVC plastic steel brick/clay other <br /> SCREENED INTERVAL(S)OR PUMP DI'.PTH <br /> DATE OF rNSTALLATION <br /> OTHER INFORMATION <br /> 0 <br /> I <br /> i <br /> 0953 <br /> i I I <br />