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June 22,2005 <br /> • Dear Resident- <br /> The following is an independent public health questionnaire to determine 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,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 /> Cambria 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 RECEIVED <br /> Joe W Neely,PG <br /> Senior Project Geologist J U N 2 7 2005 <br /> PO 6927 <br /> Phone (707)933-2361 <br /> Fax (707)935-6649 'BY. <br /> 270Perkins Street <br /> Sonoma,Califon ma 95476 <br /> (1) PROPERTY ADDRESS 1161 Virginia Street,Manteca,California 95337 <br /> OWNER NAME �� •� E ET DAYTIME PHONE aQ ��3 <br /> TENANT NAME.(if not owner) DAYTIME PHONE. <br /> (2)Are there any wells at the iddress listed in item 1 (circle one) <br /> YES `` , UNKNOWN NO ' <br /> . (3)Are there any wells in the vicinity of the address Itsted in item 1 (circle one) <br /> YES UNKNOWN NO <br /> (4)Are there any abandoned wells at the address lusted in item 1 (circle one) YES UNKNOWN 41NO <br /> Comments <br /> (5)Are there any basements at the address lusted in stein is(circle one) YES UNKNOWN <br /> If you answered"YES"to 2 or 3 above,please provide the following details,of 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 WELL DEPTH <br /> WELL MATERIAL.(circle one)2 PVC plastic -steel brick/clay Pother <br /> 'SCREENED IN'TERvAUS)OR PUMP DEPTH =,r c <br /> DATE OF INSTALLATION - r <br /> OTI-lp_R INFORMATION <br /> ,0 <br /> 1660 <br />