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WP0043326
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4300 - Water Well Program
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WP0043326
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Last modified
9/14/2022 9:37:33 AM
Creation date
9/14/2022 9:28:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0043326
PE
4373
STREET_NUMBER
17400
Direction
W
STREET_NAME
BETHANY
STREET_TYPE
RD
City
MOUNTAIN HOUSE
Zip
95391-
APN
20915029
ENTERED_DATE
5/24/2022 12:00:00 AM
SITE_LOCATION
17400 W BETHANY RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Borehole Specfffcations ' _ � ; `� � -� ,,Ce�icat�on Staterr>lent. � {, <br /> Depth from I,the undersigned,certify that this report Is complete and accurate to the Crest 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 08/31/2022 290813 <br /> C-57 Licensed Water Well Contractor Date Signed G57 License Number <br /> � pWR'�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_L of <br />
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