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WP0041401
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041401
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Last modified
3/11/2021 12:27:57 PM
Creation date
11/30/2020 9:09:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041401
PE
4373
STREET_NUMBER
2513
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95337-
APN
22610008
ENTERED_DATE
10/30/2020 12:00:00 AM
SITE_LOCATION
2513 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\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 /> Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State <br /> Signed electronic signature received 11/09/2020 290813 <br /> C-57 Licensed Water Well Contractor Date Signed 7-57 License Number <br /> s ,DWR`UseOnly <br /> CSG# State Well Number Site Code Local Well Number <br /> N W <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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