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WP0043381
Environmental Health - Public
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4300 - Water Well Program
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WP0043381
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Last modified
9/16/2022 12:24:37 PM
Creation date
8/11/2022 2:26:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0043381
PE
4373
STREET_NUMBER
2064
Direction
N
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
Zip
95336-
APN
21602001
ENTERED_DATE
6/10/2022 12:00:00 AM
SITE_LOCATION
2064 N UNION RD
P_LOCATION
04
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 07/19/2022 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] FT-i I i I i Fw] <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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