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WP0042002
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042002
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Entry Properties
Last modified
1/27/2022 8:34:27 AM
Creation date
1/27/2022 8:26:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042002
PE
4380
STREET_NUMBER
22584
Direction
N
STREET_NAME
DUSTIN
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
00705016
ENTERED_DATE
5/6/2021 12:00:00 AM
SITE_LOCATION
22584 N DUSTIN RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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Site Address: 22584 Dustin Rd, Acampo CA 95220 <br />Date: 6/3/2021 <br />PHOTO # 2 Well Loq. New Well Grouted from 200 ft usinq 10.3 sand cement. <br />V mix <br />15 (209) 368-5351 68-5824 <br />NAME �� \ <br />'S3 <br />DATE 6 � <br />ADDRESS e <br />PHONE(CO ( <br />!T1 <br />B SITLCO Wl C: <br />ME AM ❑=1N <br />rC ��\r r a Sty �! !mac rte} <br />UT �C-- FM AM [� TRUCK NO. TRAILER NO— <br />QTY. <br />DESCRIPTION <br />C Z CALIFORNIA ROCK AND READY MIX <br />1200 E TURNER RD <br />LDD1 CA 95240 <br />209 368-5351 <br />Merchant ID: j049 <br />fern, II: 0003 Store 0: 4039 <br />Raf 4: 0814 <br />Phone Order <br />XXXXXX nnX 3933 <br />VISA E*y Hethod: Manual <br />Total: $ /" 11169.10 <br />(Jv" <br />SALES & RENTAL A <br />If the egWpmenf la not property Cleaned afar u•n 1 -- <br />Francisco <br />- <br />Francisco Garcia Ruiz, Environmental Health Asst. <br />06/01/21 1' ; 41.15 <br />Inv 4: 000014 App • G,e: 014a k <br />transaction I0: 301152780751171 <br />Apprvd: Nine BatN: AM <br />Record ID: WP0042003 <br />Page 2 of 3 <br />EOUIPMENT RENTED <br />Freshl CAUTION <br />HAND TROWEL <br />concrete orrixeoutcMay cause eoskir, <br />injury. Ayoi� <br />HAND FLOAT <br />contact with Skin <br />skin wrierareassp Possible <br />ed <br />Wath <br />EDGER <br />water <br />any cement mixtures If <br />rinse into eyes, <br />TRAILER <br />Immediatelyget <br />with Water and promrpepmedicdtal <br />e <br />attention. KEEOOUT OF REACH <br />OF CHILDREN. <br />SALES & RENTAL A <br />If the egWpmenf la not property Cleaned afar u•n 1 -- <br />Francisco <br />- <br />Francisco Garcia Ruiz, Environmental Health Asst. <br />06/01/21 1' ; 41.15 <br />Inv 4: 000014 App • G,e: 014a k <br />transaction I0: 301152780751171 <br />Apprvd: Nine BatN: AM <br />Record ID: WP0042003 <br />Page 2 of 3 <br />
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