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WP0041231
EnvironmentalHealth
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CARROLTON
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18915
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041231
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Entry Properties
Last modified
11/17/2021 11:45:50 AM
Creation date
11/2/2020 2:12:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041231
PE
4366
STREET_NUMBER
18915
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
24538031
ENTERED_DATE
9/16/2020 12:00:00 AM
SITE_LOCATION
18915 S CARROLTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2020
Tags
EHD - Public
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274 . 275 SAND <br /> 275 281 CLAY <br /> 281 290 SHALE <br /> 290 310 CLAY <br /> Casings <br /> Casing Depth from Surface Wall Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Outside Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> 1 0 260 Blank PVC OD:6.900 in. I SDR: 0.329 6.9 <br /> 21 1 Thickness:0.329 <br /> in. <br /> 2 260 280 Screen PVC OD:6.900 in. I SDR: 0.329 6.9 1 Saw 0.045 <br /> 21 1 Thickness:0.329 Cut <br /> in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 200 Bentonite High Solids <br /> 200 1 280 Other Fill See description. GRAVEL <br /> Other Observations: <br /> 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 MASELLIS DRILLING INC <br /> Feet to Feet <br /> 0 1 310 12 <br /> Person,Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State <br /> Signed electronic signature received 10/15/2020 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> Image_01641.pdf-Permit CSG# State Well Number Site Code Local Well Number <br /> 18915 Carrolton Rd Ripon.pdf-Location Map <br /> N F <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />
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