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WP0037904
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037904
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Last modified
11/20/2024 9:09:41 AM
Creation date
9/27/2019 4:52:40 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037904
PE
2901
FACILITY_ID
FA0024443
STREET_NUMBER
17750
Direction
E
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95215-
APN
183-140-10
ENTERED_DATE
2/2/2018 12:00:00 AM
SITE_LOCATION
17750 E HWY 4
P_LOCATION
01
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Casings <br /> Casing Depth from Surface Wall Outside Slot SizeScreen <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Tif any Description <br /> Type(inches) (inches) (inches) <br /> 1 0 138 Blank PVC OD:4.500 in. 1 0.337 4.5 SCH 80 <br /> Thickness:0.337 in. <br /> 1 138 178 Screen PVC OD:4.500 in. 1 0.337 4.5 Milled 0.04 <br /> Thickness:0.337 in. Slots <br /> 1 178 183 Blank PVC OD:4.500 in. 1 0.337 4.5 <br /> Thickness:0.337 in. <br /> 2 0 192 Blank PVC OD:4.500 in. 1 0.337 4.5 <br /> Thickness:0.337 in. <br /> 2 192 212 Screen PVC OD:4.500 in. 1 0.337 4.5 Milled 0.04 SCH 80 <br /> Thickness:0.337 in. Slots <br /> 2 212 222 1 Blank PVC OD:4.500 in. 1 0.337 4.5 <br /> Thickness:0.337 in. <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> 0 130 Cement Portland Cement/Neat Cement ANNULAR CEMENT SEAL <br /> 130 134 Other Fill See description. FINE SAND TRANSITION SEAL <br /> 134 158 Filter Pack 8 x 16 GRAVEL ENVELOPE <br /> 158 162 Bentonite High Solids INTERMEDIATE SEAL <br /> 162 182 Filter Pack 8 x 16 GRAVEL ENVELOPE <br /> 182 187 Bentonite High Solids INTERMEDIATE SEAL <br /> 187 228 Filter Pack 8 x 16 GRAVEL ENVELOPE <br /> 228 232 Bentonite High Solids INTERMEDIATE SEAL <br /> 232 246 Other Fill See description. NATIVE FILL <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 WELL INDUSTRIES INC <br /> Feet to Feet <br /> Person,Firm or Corporation <br /> 0 187 16 <br /> 187 232 10.75 3282 HIGHWAY 32 CHICO CA 95973 <br /> 246 7.875 Sta <br /> Address City te <br /> 232 <br /> Signed electronic signature received 09/11/2018 812678 <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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