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WP0042331
Environmental Health - Public
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WOODWARD
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042331
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Last modified
8/5/2021 4:03:26 PM
Creation date
7/26/2021 4:44:33 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042331
PE
4373
STREET_NUMBER
1821
Direction
E
STREET_NAME
WOODWARD
STREET_TYPE
AVE
City
MANTECA
Zip
95337-
APN
22405035
ENTERED_DATE
7/22/2021 12:00:00 AM
SITE_LOCATION
1821 E WOODWARD AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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'Borehole'Speclflcaons `', 'F <br /> Certlficatlon`Statem�n ' ' <br /> .. .. ......i -... V4i^ 3F <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 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 07/26/2021 290813 <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 I I rw] <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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