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WP0043674
EnvironmentalHealth
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ELEVENTH
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4300 - Water Well Program
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WP0043674
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Entry Properties
Last modified
11/19/2024 10:20:03 AM
Creation date
9/21/2022 4:32:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0043674
PE
4374
STREET_NUMBER
640
Direction
E
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376-
APN
25025015
ENTERED_DATE
8/24/2022 12:00:00 AM
SITE_LOCATION
640 E ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Borehole Specifications Certification Statement: <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole Diameter (Inches) <br />I. the undersisned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name HENNINGS BROS DRILLING CO INC <br />Person, Firm or Corporation <br />1930 LADD RD <br />Address <br />MODESTO <br />city <br />CA <br />State <br />95356 <br />Zip <br />Signed electronic signature received 09/20/2022 290813 <br />C-57 Licensed Water Well Contractor Date Signed 0-57 License Number <br />DWR Use Only <br />CSG#State Well Number Site Code Local Well Number <br />N W <br />Latitude Deg/Mln/Sec Longitude Deg/Mln/Sec <br />TRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page _2_ of _2_
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