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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 Yosermte 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 tnformation 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. <br /> Joe W Neely,PG <br /> Senior Project Geologist <br /> PG 6927 <br /> Phone (7(Y7)933-2361 J U L 0 7 2005 <br /> Fax (707)935-6649 <br /> 270 Perkins Street <br /> Sonoma,California 95476Y: <br /> (ly PROPERTY ADDMS 206 Pacific Road Manteca,California 95337 �[ <br /> OWNER NAME DAYTIME PHONE — o �'� �I T I <br /> 17-NANT NAME (if not owner) DAYTIME PHONE <br /> (2)Aro there any wells at the address listed in item 1 (circle one) - <br /> G�) i UNKNOWN NO - <br /> (3)Are there any wells in the vicinity of the address listed in item 1 (ctrcle one) <br /> YES UNKNOWN NO <br /> (4)Are there any abandoned wells at the address listed in item 1 (carne one) YES UNKNOWN NO <br /> Comments <br /> (5)Are there any basements at the address listed in item 1 (circle one) YES UNKNOWN NO <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 OWNI3R tLD Alk <br /> WELL WA'T'ER USE FREQUENCY OF USE <br /> WELL DIAMETER WELL DEPTH <br /> WELL MATERIAL (circle one) PVC plastic steel brick/clay r other <br /> 'SCREENED INTERVAL(S)OR PUMP DEPTH <br /> DATE OF INSTALLATION <br /> OTHER INFORMATION <br /> • <br /> 1660 <br />