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FIELD DOCUMENTS_FILE 2
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HARLAN
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15600
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3500 - Local Oversight Program
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PR0545273
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FIELD DOCUMENTS_FILE 2
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Last modified
2/3/2020 11:58:01 AM
Creation date
2/3/2020 11:00:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 2
RECORD_ID
PR0545273
PE
3528
FACILITY_ID
FA0000174
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15600
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620079
CURRENT_STATUS
02
SITE_LOCATION
15600 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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•The free Adobe Render may be used to View'elta m `.IMe romp. Hvvm ,neMMm moat ne puchnned le cenlpete,e¢ '41d revee a email form <br /> I <br /> DM use 011131 m Net Fill In <br /> File Original with OWR Slate of CANFomle <br /> 1 Well Completion Report <br /> Page 1 of Ronrcmrnrinnlbn namPlA"r stole won Numbp/Slle Numbee <br /> Owners Well Number MW-1No. e0107545 �y y�N I- w <br /> Data Work Began D211&2010 onto Work E2lided 2 201 D 4eiiluae LW <br /> Local Penhit AgencyryslA+O:WtOSr_rn nN�, Enylr°nmS0I01Y19.Alt�hM?�-- qp <br /> Permit Number $M-%_32 ._ Dem it Date 2/12/10 <br /> :GI C'CO '. Well Owner <br /> Orientation O VErikAI O Har¢ontal OAngle specpy =CIIV <br /> Drminp Nelned °^t'^g pWw uth Harlan Road <br /> Depth from Surface .. Description. .. State CA r 950 <br /> Feet le Feat Dclurlbe metedalim'n tae,eeler,m <br /> Well Location <br /> Pressure grrwt with neat cement Address 15000 South Madan Road <br /> Remove vault box City whmp County.°•+an.22 <br /> Remove upper 3 feet of well materials Latitude _ N Longitude �_�____wPatch round surface Mo. aaa' '' � � <br /> Deldm Dadmal Lat. Decimal Long. <br /> APN Book 196 Paga.Z& Pared 79 <br /> Township a Section <br /> Location Sketch ACtivittir <br /> mou ee elmm nentlelMlotnle New Well <br /> NoIM O NladilkagonlRepalr <br /> O Deepen <br /> O Other <br /> — <br /> (F)Destroy <br /> - oma rx omrMaan em r�lnl. <br /> celnnun <br /> - Planned Uses <br /> O Water supply <br /> ❑Domestic OPublic <br /> BIW-\ ❑inlgatlon ❑Industrial <br /> 1 O Cathodic Proleelion <br /> �5beo I 0Heat E)tchange <br /> Ir4ecuann <br /> O Monitoring <br /> ( O Remadiatron <br /> O Sparging <br /> South O Test wen <br /> 111M O Vapor Extraction <br /> rNar.eta ardmnaA„�.,txendlroml 000ahne.er.1, OOther— <br /> all and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Wster Level (Feet) Date Measured <br /> Total Depth of Boring - Fact Estimated Yield (GPM) Test Type <br /> "To(ai Depth of Completed Well 20 Feel Test Length (Hours)Total Drawdovm T„(Feal) <br /> *Mav not hemore relive of a wall's b term aid, <br /> Casings - Annular Material <br /> own from rhlehok wall outaldo scroen sift sae nopre farm <br /> Suurtaco DlamaMr Typrt Material Thlcknotn otnmabf Type If Any Surface Fin [hutedpdon <br /> Feel to Fond he a anmeUl nnche,siheInches Feet to Feel <br /> 'Attachments Certification Statement <br /> ❑Geologic Log - I,the unaemtgr .certify hAt this report Is Wmplate and accurate to me best of ley ImnMedge and belief <br /> O Wall Construction Dtagmm Name SSI rillinn CAmaanV <br /> Pomnn,Fmn mnamonNon rti <br /> D Geophysical Log(c) 7 North d 95776 <br /> 11 SolMler Chemical Analytes �aY sum Zip <br /> O Other Plan Signed 03 l -ta 602334 <br /> Almeh ofalEmal wermnll nefw L-ST 4w.ane vee tom — Date Si 0.57 LILLneO Number <br /> plM1?2 tee REV.ingoe IF AMITIONAL SPACE It M=I%USE NFRT C -CUnVIAY WMOErtEe FOAM <br /> i <br /> I . <br /> Y.., <br /> ll... <br />
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