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. Dear Resident October 28,2002 <br /> The following is an independent public health questionnaire to determine if any basements or rriimcipal, domestic, <br /> or irrigation wells exist near the intersection of Moreland Court and Hammer Lane, Stockton, California The San <br /> Joaquin County Public Health Services(SJCPHS)is requesting that we identify these features to the area as part of <br /> an ongoing environmental investigation <br /> Please fill out the following information to the best of your knowledge If you do not know, Just mark it <br /> "UNKNOWN" Even if there is no well or basement at the address listed, please complete item i and return the <br /> survey Should you have any questions, please contact the Cambria Environmental Technology, Inc project <br /> manager listed below or Harlm Knoll at the SJCPHS at(209)468-3442 This information can be submitted by mail, <br /> by facsimile or verbally by phone Thank 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 /> Sonoma,Calnforma 95476 <br /> (1) PROPERTY ADDRESS 2 - <br /> OWNER NAME DAYTIMEdF <br /> PHONE .20:Z -- 4247 <br /> TENANT NAME (if not owner) DAYTIME PHONE <br /> . (2)Are there any wells at the address I tsted in item I•(circle one) <br /> (ii) UNKNOWN NO <br /> (3)Are there any wells m the vicinity of the address listed in item 1 (circle one) <br /> UNKNOWN NO <br /> (4)Are there any abmWoned wells at the address listed m iters I (circle one) YES UNKNOWN NO <br /> C mmcnts. <br /> (5)Are there any basements at the addrt:se luted in item I (circle one) O UNKNOWN NO <br /> (S)is the residence at the address Baud in item 1 iii city water.(cirzte 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 /> mdncatt which well you are describing <br /> WELL ADDRESS 4 Z 4$ E. ///YJr1�i�!d WELL owNEIL � /-/tf 7,,e :�-- <br /> WELL WATER USE l✓REQUENCY OF USE, U � <br /> WELL DIAMETER. 7 WELL DEPTH ? <br /> WELL MATERIAL(circle one) PVC plzstic steel brick/day other <br /> SCREENED W"RVAL(S)OR P.UW DEPTH , <br /> 0 <br /> 0 DATE OF INSTALLATION. 7, <br /> OTHER INFORMATION <br /> � d I <br />