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WP0040589
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040589
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Last modified
6/25/2020 4:28:59 PM
Creation date
6/25/2020 10:19:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040589
PE
4689
STREET_NUMBER
3555
STREET_NAME
WILMARTH
STREET_TYPE
RD
City
STOCKTN
Zip
95216-
APN
08716002
ENTERED_DATE
3/3/2020 12:00:00 AM
SITE_LOCATION
3555 WILMARTH RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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TSok
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EHD - Public
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Borehole Specifications _ Certification Statement <br /> Depth from I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name HENNINGS BROS DRILLING CO INC <br /> Feet to Feet <br /> 0 600 10 Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 06/24/2020 290813 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use Only <br /> CSG# State Well Number Site Code Local Well Number <br /> N I JWJ <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 3 of 3 <br />
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