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June 22,2005 <br /> Dear Resident <br /> The following is an independent public health questionnaire to deternvne if any basements or municipal, <br /> domestic, or irrigation 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,dust 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) 468-3456 This information can be <br /> submitted by mail,by facsimile or verbally by phone Thank you for your cooperation <br /> CAMBRIA ENVIRONMENTAL TECHNOLOGY,INC <br /> Joe'W Neely,PG <br /> Senior Project Geologist JUN 2 7 2095 <br /> PG 6927 <br /> Phone (707)933-2361 <br /> Fax (707)935-6649 BY• <br /> 270 Perkins Street <br /> Sonoma,California 95476 <br /> (1) PROPERTY ADDRESS 1141 Viraiiva Street,Manteca,California 95337 _ GG <br /> OWNER NAME' r DAYTIME PHONE q) g3 <br /> TENANT NAME (if not owner) DAYTIME PHONE( <br /> (2)Are there any wells at the address listed in item 1 (circle one) - <br /> ,YES r UNKNOWN <br /> (3)Are there any wells in the vicinity of the addieess listed in item 1 (circle one) <br /> YES UNKNOWN NO <br /> (4)Are there any abandoned wells at the address listed in item 1 (circle one) YES UNKNOWN No <br /> Comments <br /> (5)Are there any basements at the address listed in item 1 (cucle one) YES UNKNOWN ONO <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 /> WELL ADDRESS WELL OWNER <br /> WELL WATER USE. FREQUENCY OF USE <br /> WELL DIAMETER WELT.DEP H <br /> WELL MATERIAL.(circle one) PVC plastic steel bnck/clay other <br /> SCREENED INTERVAL(S)OR PUMP DEPTH <br /> DATE OF-INSTALLATION. - <br /> OTHER INFORMATION <br /> 1660 <br />