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WP0041146
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SAMRA HAYER
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041146
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Entry Properties
Last modified
1/27/2022 9:03:01 AM
Creation date
1/27/2022 8:56:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041146
PE
4366
STREET_NUMBER
23020
Direction
N
STREET_NAME
SAMRA HAYER
STREET_TYPE
LN
City
ACAMPO
Zip
95220-
APN
00737021
ENTERED_DATE
8/25/2020 12:00:00 AM
SITE_LOCATION
23020 N SAMRA HAYER LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2020
Tags
EHD - Public
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Site Address: 23020 Samra Hayer Ln, Acampo CA 95220 <br />Date: 9/2/2020 <br />PHOTO # 2 Well Loa. Grout seal set from 100 ft. <br />I <br />Record ID: WP0041146 <br />A71ifornia Rock & Ready Mix <br />'� _ • 122103 <br />1200 E. Turner Rd. •Lodi, LA 95240 <br />0�) 368 5824 <br />J`I (209) 368-5351 Fac (2 <br />DATE <br />NAME % .nr/i l ' pHONE` <br />•� J <br />ADDRESS <br />TE Am u "°'� PM ❑ <br />IM <br />PM ❑ �N nalCE AMOUNT y <br />OUT DESCRIPTION <br />Usr/ ���Wl tp �fa24li <br />209 3G.o-S'iS1, <br />nzl"a»n� w: uaa9 st <br />ter• it: OW3 Rrr nr <br />Sal e <br />wwy=5501 <br />f Pethod: Cnra <br />V15A <br />EQUIPMENT RENTED PRICE Total; $ 1,o7.1.68 <br />����� HAND TRD\NEL <br />CAUTION mortar, HAND FLOAT v; gra <br />fBshly mixed cement, skin EDGER &Q13vz0 <br />rout may cause skin <br />concrete or,� contact with Inv b. ptJ13 fpr Code; t �J <br />In�ary 035ib1e and wash exp°Sed TRAILER <br />w Zero P,. Tom d wlttl, water. If Z C5�1 6 -`. <br />sVon areas P P et into eyes. T1Can58C�\6plC'• 3a� <br />any cement Mixture a 9d repe et�dlal tya, polus <br />rinse mmedr ���ol promODt PEACK <br />wiieN or rKEEP OUT <br />RENT Py- AGRE CAQl�I� 1h�e <br />of& c1+tLonely. g ssc h}p: ue�" <br />SAI. -E n <br />0hrens b paY a <br />plt0r usu, lose 5 per \wu. on wn tSU F8VF0 655.\ •. <br />. u thu n9mpnu:,a is not M�Paoyu ihood`"o horns, loo of s-• \VR'• �`� <br />11 1'• moat <br />has 1 on de1N ena'ChB W1< lol'et ••�• <br />0 <br />onuip warn <br />. e nw cl I tun ` use allove a a1x1 slpn ltds�e�9,,�i i awee to r+av <br />rn,lrtfn1 oWlOrlr]Oy pial\he 1101(1 a1n,1s good cpnddbl\aS ordl is <br />� Xtems <br />vre <br />. Yne I s1s sCkn mad10 r. «ailor WIWI aohe lH cc>a^- j/ <br />- nnn ho u0luos tU PaV 10 rotum the �p1 1C �� \he <br />con,nil hw Ieusmt r,r}alpmsnl s11d lura 1n.,pactud i�\alb}6oru <br />rnI 1D ny Thal, "00WUp so wtldop\s1 iae ;� r <br />son a,Nnowledp ' trnlfor and d eyulpmenl & ge'al C <br />. shot for sold lease ard}a flecM <br />n:d Urd ho hfly inw1A tho ppsihldoi save Cant 1lopedy that maY x�Y <br />q Bunn V, 3 -on ull ,eti s In his person M 1 accident. the <br />.the lussnn Iminor apreu5 to in domndy anA <br />LN <br />damap \n \he event o1 aM <br />In11 Y i 1°ry <br />nl hls u1 \rah <br />custody 1t lnb u� o <br />p: ri 1U W nil .ill k1w u5 11 m. \ h -'.-^- <br />C.alltoul,,,poat urt.rdY mtu:na nor V a. A <br />1 <br />. t 11n la> µfV`11 D�in10iV tui hi , dlyi\. _ .. - <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 2 of 3 <br />
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