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WP0041588
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041588
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Entry Properties
Last modified
2/6/2025 11:51:57 AM
Creation date
5/11/2021 9:55:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041588
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
30003
Direction
S
STREET_NAME
KOSTER
STREET_TYPE
RD
City
TRACY
Zip
95304-
APN
25532003
CURRENT_STATUS
Inactive
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
30003 S KOSTER RD TRACY 95304-
Tags
EHD - Public
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' -Casings. <br /> Casing Depth from Surface Wall Outside Screen Slot Size <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Type If any Description <br /> (inches) (inches) (inches) <br /> 1 0 130 Blank PVC OD:8.625 in.I SDR: 0.41 8.625 <br /> 211 Thickness:0.410 <br /> in. <br /> 1 130 160 Screen PVC OD:8.625 in.I SDR: 0.41 8.625 Saw 0.05 <br /> 21 Thickness:0.410 Cut <br /> in. <br /> Ann't�[arM;aterial <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 100 Bentonite High Solids <br /> 100 160 Filter Pack Other Gravel Pack No 6 sand pack <br /> Other Observations: <br /> •,t,. _ '•' a.:. a.t tit° ..,1§r i i � 1�'2'<Y' _.2. i c._ ,� <br /> b4il atement <br /> Ce�tlfica#� x <br /> Boreholi�Specif cations � ;z{�,,� , �{ - <br /> .. <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 /> 0 160 1 14 <br /> Person,Firm or Corporation <br /> 1930 LADD RD MODESTO CA 95356 <br /> Address City State ��— <br /> Signed electronic signature received 05/05/2021 290813 <br /> C-57 Licensed Water Werl Contractor Date Signed C-57 License Number <br /> CSG# State Well Number Site Code Local Well Number <br /> N I I I I [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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