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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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06/07/2000 12:43 7073745677 WDODWARD DRILLING CO PAGE 02 <br /> Well Drillers Authorization Letter r <br /> Site Address_5491 F st. NpR011iA , <br /> 7 Y�LTI <br /> City Banta CA 0.0 <br /> Well DrilleriNoodwaed Drllinn Co.- Inc k <br /> Drillers Address P.O. Box 336 JUN - 72000 <br /> "'p <br /> City, State, Zip Rio'Vista, CA rs <br /> l� <br /> - — 9457'! , . � Rt ,yj,,vF, ! ,:,- <br /> - PERMi► /SEi�Vi: c <br /> Drillers Phone# (707) 374 4300 <br /> C-57 license# 710079 Exp. Date 7/31/2001 <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 Saourakis <br /> Company: APEX <br /> i <br /> /address: 70"Madison Ave. <br /> City, State, Zip Fair Oaks. CA, 95628 - <br /> I understand that as the applicant for permits, I 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: G-7-00 <br />
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