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WP0045027
EnvironmentalHealth
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120 (STATE ROUTE 120)
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22392
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4200/4300 - Liquid Waste/Water Well Permits
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WP0045027
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Last modified
11/19/2024 4:01:51 PM
Creation date
1/31/2024 3:16:11 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0045027
PE
4370
STREET_NUMBER
22392
Direction
E
STREET_NAME
STATE ROUTE 120
City
ESCALON
Zip
95320-
APN
24509017
ENTERED_DATE
11/6/2023 12:00:00 AM
SITE_LOCATION
22392 E HWY 120
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\gmartinez
Tags
EHD - Public
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Casings <br /> Wall Outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet Casing Type Material Casings Speciticatons Thickness Diameter Tif any Description <br /> Type(inches) (inches) (inches) <br /> 1 0 233 Blank PVC OD:6.900 in.I SDR: 0.329 6.9 <br /> 21 1 Thickness:0.329 <br /> in. <br /> 2 233 253 Screen PVC OD:6.900 in.I SDR: 0.329 6.9 Saw 0.045 <br /> 21 1 Thickness:0.329 Cut <br /> in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 110 Bentonite High Solids <br /> 110 1 253 Other Fill See description. BIRDS EYE GRAVEL <br /> Other Observations: <br /> Borehole Specifications Certification Statement <br /> Depth from I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> Surface Borehole Diameter(inches) Name MASELLIS DRILLING INC <br /> Feet to Feet <br /> 0 255 12 Person,Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 11/16/2023 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR Use Only <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 2 of 2 <br />
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