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WP0043483
EnvironmentalHealth
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4 (STATE ROUTE 4)
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14210
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4300 - Water Well Program
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WP0043483
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Last modified
11/20/2024 9:09:43 AM
Creation date
7/28/2022 3:55:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0043483
PE
4373
STREET_NUMBER
14210
Direction
W
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95215-
APN
13112004
ENTERED_DATE
7/8/2022 12:00:00 AM
SITE_LOCATION
14210 W HWY 4
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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Certification Statement <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name PITCHER SERVICES LLC <br /> Person, Firm or Corporation <br />2726 Walnut Avenue Signal Hill 90755CA <br /> Address City State Zip <br />Signed electronic signature received <br />C-57 Licensed Water Well Contractor <br />07/28/2022 <br />Date Signed <br />1044895 <br />C-57 License Number <br />DWR Use Only <br />CSG #State Well Number Site Code Local Well Number <br />N <br />Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br />TRS: <br />APN: <br />W <br />Borehole Specifications <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole Diameter (inches) <br />Attachments <br />Well#2---6 in Steel Csg. TD 71' - GPS.jpg - Location Map <br />6 inch Steel Well - Street View.jpg - Photo <br />Page 2 of 2 Form DWR 188 rev. 12/19/2017
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