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SERVICE REQUEST <br /> Facility ID Facility Name <br /> Record ID 014419 Location 413 MT. DIALBO AVE, TRACY <br /> eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee <br /> Property Owner CHEVRON PIPE LINE COMP <br /> Business Name C/O KATIE HOWER <br /> Street Number Dir Street Name Type Unit <br /> 4000 _ EXECUTIVE RD 400 <br /> 2nd Address PO BOX 5059 <br /> City SAN RAMON, State CA Zip 94583-0959 <br /> Phone 1 510-842-6877 Ext APN <br /> Phone 2 - - Ext <br /> Census 000001 District 005 Location 03 Citycode <br /> Requestor ANN OUASSOU, RG/EMCON-FRESNO <br /> Business Name V & W DRILL, C-57 #720904 <br /> Address 1 <br /> Address 2 PO BOX 51 <br /> City RIO VISTA, State CA Zip 94571- <br /> Phone Number 707-374-2815 Ext <br /> Nature of Service Request - <br /> APPLICATION WITH CVRWQCB/W. COHEN OK, TO DESTROY THREE (3) <br /> ONSITE MONITORING WELLS BY PRESSURE GROUT PER WELL STANDARDS . <br /> SERVICE REQUEST <br /> eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee <br /> Comments - <br /> MW-1 IS 4" PVC WELL TO 35' BGS . . MW-2 AND 3 ARE 2" PVC TO 30 ' BGS .GROUT <br /> IS TO BE CEMENT W/30-. BENTONITE. EMCON FRESNO CHECK #02649 SUBMITTED. <br /> Name Date Time <br /> Received By 0684 INFURNA, MICHAE 12/05/97 <br /> Assigned To 0684 INFURNA, MICHAE 12/08/97 <br /> Date Service Completed _/_/_ Requires Further Action Y/N Y <br /> Amount paid 60 . 00 Program/Element 2902 <br /> Due date <br /> OaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaG <br /> ° This record was entered on 12/08/97 By STAFF ° <br /> ° This record was last updated on 12/08/97 By STAFF ° <br /> aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaai <br />