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ARCHIVED REPORTS_XR0011837
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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F
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5491
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3500 - Local Oversight Program
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PR0545028
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ARCHIVED REPORTS_XR0011837
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Entry Properties
Last modified
12/6/2019 5:25:56 PM
Creation date
12/6/2019 4:35:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011837
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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{ <br /> J , <br /> i <br /> ORIGINAR <br /> •TAT;of CALWORNIA <br /> Hie Wi}tl DWR TH& RESOURCES AGENCY Do not flu it <br /> DEPARTMENT' OF WATER RESOURCES 1 <br /> N,.-,-,.r[n N or WATER WELL DRILLERS REPORT �Q` 5 214 0 <br /> Ircrnrnit No.or Date �+ `L <br /> State Well No. <br /> (!) OWNER: Other Well No. _Z <br /> Nam B3I P � i <br /> j %ridresr 808 Grantline Road (12) WELL LOG: -r,x,,F-p—h-84-ft. r <br /> city Trac Calif. (c)nk rt. to k. Format; never at�a)atad wal�E�jr <br /> Formation !Describe by arias, character, .fxe nr maeerlrnl) <br /> (2) CAT OI�I O xip 4 Sand to Soil <br /> WELL (See instructiotu): <br /> c,nrnly 11'1 <br /> JON 1'1 - Cx .r a11{Z sand layers <br /> (hwme.+ Wali Number ' <br /> %%'ctf address i!di�ffsrr nt Gam aro. ' � Gam]ay i <br /> luwnxhip Ran �. _ <br /> Sand <br /> � <br /> _ <br /> Mitance from cltiex,ran SectilrF�. <br /> ds railnrads,fences,etc am@ aut1Z'Braej ry�j "J� �►, _ \�� <br /> 7i <br /> San - <br /> (3) <br /> 5,31(3) TYPE�rOF WORK, <br /> fid' p�lT'� eW We" 2F Deepening❑ <br /> fhb Reconstme trra <br /> o Pct we er was ns a p F <br /> `C Hecnrndifloninq 0 S -we 2ll1o res <br /> � <br /> Horizontal Well Clany a r <br /> ,� Deatnrctfart ❑ (Descn�e -or ea ,� € <br /> = <br /> prncedUn*dastrrrenotellah F <br /> rq ]n Ifem v'F <br /> (4) PROPOSED ; <br /> jDomestic \ <br /> industrial <br /> %ty <br /> ] - . <br /> `Q ` A> `> <br /> - ,•,N <br /> WELL LOCATION SK£TC#r �, <br /> r' Other -'1 ❑ > <br /> €7J EQVIPh!£NT: <br /> f 6) GRA PACICr ``� <br /> `- <br /> Cable p Ar �everae q � NO <br /> Q r of bare <br /> Other ❑ Bucket �+\`\l <br /> Q ��le .iM <br /> (7) CASING INSTALLED..%%� —.fit• <br /> ftI!'PERFt]HA9'fBN ,� .•� <br /> Segel Q P1astic36 C crete. Type at pe Or of scree <br /> From To Dia. r F <br /> ft i In. wall �� <br /> 0 T O .0 8 „ <br /> f 9) WELL SEAL: <br /> %Vas surface sanitay seal provided? V".[X[X No ❑ If yea• to deq�h• <br /> %Vera strati sealed altainst pa]]utkM? Yet ❑ jY <br /> Atelhrrd eOt Interva>�_ rt <br /> of sea' <br /> (10) WAT'ER LEVELSt Work start Cam t <br /> Depth of Ant water, if kno WELL DRILLERS ST'ATE%fE 9 <br /> Standintt level afttt well rompkt(o Tkis neeR tea if under my ps a this re i <br /> (11) WELL knou;ledtia e(1 se n a ray <br /> TEsrst <br /> %Bess wrll test made? Yes 0 Na EX If Yes, by whrun? SIG\ - <br /> TYpe of fret Pump 0 � <br /> Railer 0 Air tiff We <br /> eyth to water at start of tes�rk. ❑ NAME r <br /> At end of teu� (Person,Atm,ae eo <br /> mehrrgeC —��al/min after rvorntiaa) (1' printer}) <br /> ^�----Fours Wales tempers Add " <br /> t lel analysis rnnde? Yu ❑ Na Q I[ yes, by whom? City <br /> %Des electric b,y made? Yea Na Ci It 'G <br /> yes•attach ropy to this report Ilcegsa Na <br /> nwR tee (esv.s.ye) IF ADDITIONAL.SPACE 1S N6EDED, ..............VSE NEXT CONSECUTIVELY NUMBKRKD FORM .. <br /> 1 <br /> So- d OTn' ON i7n: ';T - _Clfl._7T .?IAH 000l__1771fTT _ I ,T\1I T <br />
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