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1Z. <br />9 <br />What is the depth to , OundwSter? <br />Describe the source of Wormaiion: <br />Unknown by contractor <br />Are there sag Water walls on this parcel or adjacent properties? <br />TYPE OF 7ELL3 } Di'TXIICE TO T.MMS(S) <br />pubIIeWell 100 fw <br />E <br />PL's7ate l I <br />it <br />Irri=",-I� <br />Honitoriner well <br />ft <br />[Other <br />I <br />`ES It xO t 1 <br />IK <br />14. 1FU the tarXsj penosure be replaced with art abavagraund of �dergrauad;t�cags taak(sI YES I KO[ <br />dia.: closure <br />15. Indicate the resTonsible party tD be Swed for additional PHS -BIB staff time expended beyond 3 hour minittta m peratt p27MVE <br />per mak. if the parts desiViated below is differed thea I$ pgrrait aPP11 nt, e.g. prapertp owner, the party must aclmoWledCl <br />rids raponsibility for the bMg b? sign=rs and date helm <br />California Water Service <br />Name <br />Mana.e4dd-ress 1602 E. Lafayette St., Stockton, CA 95203 <br />Day Pho'teNmnher2( 09 ,) 464-8311 <br />,) Superintendent <br />glgxature Tice <br />Pa <br />;�'.ev scd M'13 991 ge F <br />11/13/00 <br />Date <br />