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WP0039998
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039998
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Last modified
10/22/2019 2:41:27 PM
Creation date
10/1/2019 11:35:54 AM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039998
PE
4373
STREET_NUMBER
2317
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337-
APN
19817033
ENTERED_DATE
8/23/2019 12:00:00 AM
SITE_LOCATION
2317 W YOSEMITE AVE
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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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 /> Person,Firm or Corporation <br /> 119 ALBERS ROAD MODESTO CA 95357 <br /> Address City State Zip <br /> Signed electronic signature received 10/04/2019 668622 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> Attachments DWR Use Only <br /> 2315 W Yosemite AVe Manteca.pdf-Location Map CSG# State Well Number Site Code Local Well Number <br /> Image_00301.pdf-Permit <br /> : LFELIF iJ—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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