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jvhul Scan jolly in lY►✓I <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 9520M232-(209)469-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> _N <br /> Joe ADDRESS 21120 EI Rancho Rd cnv2lp Trac 34 <br /> CROSS STREET S of Canal Blvd <br /> APN 213-160-25 PARCELSIZE�LgND USE APPLIDgTGN# <br /> w <br /> OWNER NAME Tony Silva It Tf PNONE 209-649-8600 <br /> OWNER ADDRESS 21120 EI Rancho Rd cnrwsTATE/LP Tracy.CA 95304 <br /> CONTRACTOR Hennings Bros. Drilling CO.,Inc. PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd CITY/STATEZP Modesto,CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CRY/STATEMP <br /> LICENSE X C-57 i,C-61 D-09 i Other NUMBER 290R73 E%PIRATONDATE_05-31-2018 <br /> GEOGRAPHICAL INFORMATION: CoordinatesX Y Township_ Range_ Section_ <br /> INTENDED USE y(DOmeSfic/Privete .Irrigation/AgdwMURTI C InduSMel ]Water Quality Monitoring ]Soil Sampling/CharachInzation <br /> ] <br /> Public Water <br /> eaowa mame omeact Name or Prome Numser <br /> TYPE OF WORN ytNew Well 0 Replacement Well C Well Alteration/Modification ]Other <br /> ]Monitoring Wells) #of Wells 0 Soil Borings) #ortoae9P C Geotechnical #Of aOd"a' <br /> ]Out-Of-SerWce Well C Out-Of-Service Well Renewal ❑Crass-ConnecBOn Repair <br /> ]New Pump ]Pump Replacement 0 Pump Repair D Raise Well Casino <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary ]Air Rotary L Auger ❑Cable Tool 0 Push Point D Other <br /> Proposed Well Depth 200 R Excavation 14 in diameter 0 Open Bottom X Gravel Pack/Gravel Size No.6 in diameter <br /> i Conductor Casing in diameter / Conductor Casing Depth it Sand pack <br /> Well Casing Diameter 8 in Thickness/Gauge/ASTM Sched SDR26 0 Steel XPlaMk, D Stainless Steel 0 Other <br /> Grout Seal Depth ion it ❑Neat Cement(94 ID Dag15-T0 gal water) DSand Cement sack new7 gal water <br /> X Bentonite(20%solids) ]Other <br /> Grout Placement Method XPumped a Free Fell U Other J Retardant/ACcelerator(name) <br /> PED�Es rAL inaMlletl By ❑Driller XPump Contractor ❑ Other <br /> ]Concrete Pedestal Dimensions:Width it Length R Thick to 0 Christy Box 0 Stove Pipe <br /> PUMP ]Submersible❑Turbine ❑Other HP Pump Set it Standing Water Level R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATIONLAWS. <br /> MUM 24 HOUR ADVANCE DyPNSPECTIONS <br /> SIGNED DAM L -A-)-7 <br /> rF <br /> "C7 ge <br /> DE ARTMENT U ONLY <br /> Application Accepted By Date�� Area �+ I L {.EmplOyee ID# <br /> Grout Inspection By Date SPTECIAL WeII Permit <br /> Pump Inspection By Date---v- WAIVER Received <br /> Soil Bating Inspection By Date Constructed Well Depth It <br /> COMMENTS CA <br /> PE SC Received i[Checko/..0 Amount Data Permit/ Invoice# Well IDN <br /> Codes Info B Remitted Service Re uest# <br /> 3 U Cb <br /> EH04309 WOUPUMPPERMR <br /> 8eM09 <br />