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June 22,2005 <br /> Dear Restdept <br /> The following is an independent public health questionnaire to determine if any basements or municipal, <br /> domestic,or imgation wells exist near the intersection of 1160 West Yosemite Avenue and South Union <br /> Road,Manteca,California The San Joaquin County Environmental Health Department is requesting that <br /> we identify these features in the area as part of 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 1 and <br /> return the survey in the postage-paid envelope provided Should you have any questions,please contact the <br /> Cambna Environmental Technology, Inc. project manager listed below, or Victoria L. McCartney at the <br /> San Joaquin County Environmental Health Department at (209)r 4o�c3456 information can be <br /> submitted by marl,by facsimile or verbally by phone Thank y oY cooperation. <br /> CAMBRIA ENVIRONMENTAL TECHNOLOGY,INC <br /> Joe W Neely,PG <br /> Senior Project Geologist <br /> PG 6927 <br /> Phone (707)933-2361 <br /> Fax (707)935-6649 <br /> 270 Perkins Street <br /> Sonoma,California 95476 <br /> (1) PROPERTY ADDRESS 344 Pacific Ro Manteca.California 95337 <br /> OWNER NAME A/�1 Tb Oy _S�to DAYTIME PHONE �� <br /> TENANT NAME (if not owner) DAYTIME PHONE <br /> (2)Are there any wells at the address listed in item I (circle one) <br /> (f) - - - UNKNOWN NO <br /> (3)Are thane any wells in the vicuuty of the address listed in item 1.(circle one) <br /> UNKNOWN NO <br /> (4)Are there any abandoned wells at the address listed in item <br /> sn 1��.(circle one) YES UNKNOWN NO <br /> Commants <br /> n� ac.B <br /> ,6 KntY-d t�J�a. O—C,If D S S <br /> (5)Are there any basements at the address listed in item 1 (circle one) YES UNKNOWN <br /> If you answered"YES"to 2 or 3 above,please provide the following details,if possible If there is more than one well, <br /> please indicate which well you are describing <br /> �[� t go? WELL OWNER 1]—/V <br /> WELL ADDRESTo+Vto �` SO Q re, <br /> WELL WA'T'ER USE- ��REQUENCY OF USE L <br /> WELL DIAMETER �!I WELL DEPTH <br /> (WELLMATERML.(circle one) PVC plastic steel bricklclay other <br /> SCREENED INTERVAL(S)OR PUMP DEPTH <br /> DATE OF INSTALLATION <br /> OTHER INFORMATION <br /> tvc-tjo n a 72) <br /> • t,,' l Lia16 7, y,.t ' '�¢�t"' ► �C arm- -4 '` r r�/ <br /> l Xl t�c.��` `�/s feu <br /> aeaw <br />