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FIELD DOCUMENTS_FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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5491
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3500 - Local Oversight Program
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PR0545028
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FIELD DOCUMENTS_FILE 1
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Last modified
12/6/2019 2:57:11 PM
Creation date
12/6/2019 2:44:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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j7/2000 12:43 7073745577 4dDODWARD DRILLING GO PAGE 02 <br /> r <br /> Well Drillers Authorization Least �'- `. <br /> Site _ <br /> e Address: 5491 F st. r-N, i? <br /> City Banta CAS �- <br /> Well �is, IiRto� c; <br /> Driller <br /> Woodward Drilling-Co.,Co. Inc <br /> Drillers Address P.O. BOX 3313 <br /> JUN - 72000 <br /> City, State <br /> zip RIO UIStc'>i CA �rJ71 <br /> Drillers Phone# 7Q7 374=4300 <br /> C-57 License# 710079 Exp. Date 7131/2001 <br /> For the sole purpose of procuring permits for drilling, well construction, and well <br /> destruction's, I hereby designate the following entities to act as our authorized <br /> representative. <br /> Name: Mike Swurakis <br /> Company: APEX <br /> Address: 7844 Madison Ave. <br /> City, State, Zip Fair Oaks CA 95628 <br /> 1 understand that as the applicant for permits, 1 am responsible for compliance <br /> with all provisions of the permits. I also understand that upon written notification, <br /> that I may rescind this Authorization. <br /> Signed: <br /> Printed: Erik Forsstrom <br /> Date: 6-7-00 <br /> - I <br />
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