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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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SJGOV\sballwahn
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EHD - Public
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•.'Tho into pdobD Render may ha reed Ie Now Ima fiie rano, Hawcwr,PPIWam moat ba purchased m eomRude,! .umd rcuae a Paved corm, <br /> File Onglnal with bWR Stale Of California DwR Uae rel ..DO Nm FstM <br /> Paget of 1 Well Completion Report <br /> aeon ft,M MIAMI=r PRUPW SINn VVPII Nlmtber/ahe Numbs <br /> Owners Won Number MW-13A1B N0. e0107564 I T N L—i T-i--1 ;WW1 <br /> Data Work Gegen 07/16/2010 Dale Work llcltletl 2l19l201Q Lemuee L 'tulle <br /> Local Permit Agenryrounty Envlranmantal Realm Ijrnt <br /> Permit Number SR59335 Permit Dade 7112110 APNItR$IDtnm <br /> ; ...OeOlb lok :; vVell Owner <br /> Orientation OVernnol 0Horizontal OAngle Soeeny Name Oalwlnder Ohoot <br /> Drilling Merged Drilling Fluid MaRing Addra88_15600 South Harlan Rpl; <br /> Depth fromSuffaco .. .DascYplfon <br /> Feet Lathrop <br /> a Fact Pcdbe mnlerlel,' rain step clror etc C State C,R Xi B53y3,�� <br /> Well Location <br /> Pressure grout With neat cement Address F Road near1550S,Harlon R <br /> wd <br /> Remove Vault box - - City LethrooCounty sen Joaquin <br /> Remove upper 3 feel of well mateffals Latitude N LOnghude v w <br /> Patch ground surface oea, win. eor, 1361 Mm. a¢. <br /> Datum Decimal L,'L Declmol Long. <br /> APN Book Page Parcal <br /> Tow R!me Section <br /> Location Sketch AcWty neilre.0 nem Nin leml 1. O Nma Wall <br /> North O ModlRcallonlRcpak <br /> 0 Deepen <br /> �y§tID O Deesirohy <br /> Planlfatl USOa I <br /> 15550 OVU;APr kp❑Public <br /> ❑Irrigation ❑kldusklal <br /> 0 Cathodic Protection <br /> S O Dawaledng <br /> 0Heat Exchange <br /> 0 btfedlon <br /> O Monitoring <br /> 0 Remcdiaaon <br /> Spiuging <br /> South O real wen <br /> nusMeoreeMabe dlameN.,nortew.ennht,em,q.,one.,, O Vapor Extraction <br /> rMxr.ao.ma mnen.Mae.u...enxro.neweru6e, r. 0Other <br /> nw..bmaxNe• Me. <br /> Water Level and Yield of Completed Well <br /> Depth to nmt vrater (Fast below surface) <br /> Depth to Static <br /> Water Level _ (Feet) Date Measured <br /> Total Depth of Bering Feel Estknated Ylcld' ((3PM) Test Type <br /> 'rota)Depth Ofcompleted Uvea 30 Feet Test Length (HQUM)Total Dromown_(ITen <br /> 'Ma out he M ac lathe of a well's long term yield. <br /> Casings ' Annular Malarial <br /> Depth Rom Borelrolo yypc - WAR Outside screan Slota� Depth ga <br /> Feet to Fm <br /> M61gflP1 <br /> su I. F utsrdate Tkmk860v DiameterTypo NAM surface FIII Descninlon <br /> oal Inc1188 � - ncneP neMPalVacant Foot I. feet <br /> `Attl'cllmettls. Certification Statement <br /> 13 Gemoglo Log L me under-mad,pExtlfy that l"a Iapixt Is complete and accurate to the 110%Of my knowledge and ballet <br /> El Wall Cormtructlon Diagram Name M. III nD.Co ny <br /> ❑ Pimm,t mor CNpMiln <br /> Gebptryslcal Log(s) estShreet WoodiiiEW 95776 <br /> 0SelIMlalarCnomlemAnalysesars cl III" zp <br /> C]Other Site Plan Signed _ l "7-6b 802334 <br /> A .dd,vonm r menu cmtlmnnneWNervvescerNaetee Date laned C-57 License Number <br /> WJR'SA REV.In= IF ADMICIML SPACE IS NEEDED,USE NEXT CMECUTWLY NUMMASO PCRM } <br /> f <br />
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