Laserfiche WebLink
-Tv,44 5Utn a aII(D �^ <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEM 1868 East Hazelton Avenue-SrocATONCA95205.8332-(209)488-3470 <br /> NDN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED (tttteeee <br /> Joe ADDRESS 1651 N Beecher Rd Well#1 cmmP Stockton 95215 {I <br /> CROSS STREET S.of Hwy 26 APN 103-020-09 PARCEL$RE NDUSEAPPUCATGN# (! <br /> i <br /> OWNER NAME n PHONE 607-1078 <br /> L <br /> OWNER ADDRESS Cnv/$TATEMP Stockton_CA 95212 <br /> CONTRACTOR Hennings Bros. Drilling Co. Inc. PHONE 209-545-1185 <br /> CONTRACTORADDREsa 1930 Ladd Rd CIwISTATEMp Modesto,CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRE88 CITwSTATEMP <br /> LICENSE R C-57 3 C-61 ❑D09 C Other HuMeent 290813 EZHeADoN DATE 05-31-2018 <br /> GEOORAPHICALINFORMATION: Coordbaba% Y Township_ Range_ SeeOon_ <br /> INTENpED UsE C DomeadPrivate k ImgatiaNAiinaN9ural ❑Industrial 7 Water Quality Monitoring D Sod Sampling/Chaecterization <br /> Public Water System <br /> If Ma.lmm owns sNM.. -- <br /> TYPE OF WORN R New Well C Replacement Wel C Well Alerotion/Modifiretion ❑Other <br /> ❑Monitoring Wel(s) aof walla ❑SON Boling(s) 001,Iwt is C Geotechnical Sul ewmee <br /> C Out-Or-Service Well C Out-OtSerace Well Renewal ❑Cross-Connection Repair <br /> I Naw Pum Pump Replacement I I Pump Repair i Raise Well Casin <br /> WELL CONSTRUCTION <br /> Drilling Method C Mud Rotary ❑At Rotary C Alger D Cable Ted D Push Print ra other Reverse Rotary <br /> Proposed Well Depth 500 fl Excavation 2r_in diameter C Open Bosom R Gravel PacklGravei Size 6/8 blend in diameter <br /> X Conductor Casing 30_in diameter / Conductor Casing Depth sn g <br /> Well Cuing Diameter 16 in Thidmess/Geuge/ASTM Schad 1/4" U Steel D Plastic C Stainless Steel C Other <br /> Grout Seal Depth 50 It C Neat Cement(94/11 bap/S-10 gel rimier) at Send Cement 10.3 Sack sack mixn gal wed <br /> ❑Bentonite(20%solids) ❑Other 30"x 59 Conductor Cemented in <br /> Grout Placement Method N Pumped T Free Fall C Other C Retardant)Accelerator(name) <br /> PEouTAL Imblbd Byi Ontier M Pump Contnrfor I I Other <br /> Conerob Padub)Dlmenabns:WMIh_e Length gThick in iChristybox Stow Plpa <br /> C SubmersibleO Turbine C Oler HP Pump Set R Standing Water Level R <br /> 1 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. 1 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 COMPENSATION)AWB. <br /> MINIMUM 24 HOUR ACIVAIJCE'IJOTICE REOUI{�j? ( FOR INSPECTIONS <br /> SIGNED 'Ike rte__ dyV�\L. I ' DATE <br /> CIL — <br /> FFFFF <br /> REGY <br /> we <br /> DEC <br /> SA EN�t <br /> HEpt,TH <br /> D� ARTMENT E NLY <br /> Appgcetian Accepted Date AreaEmployeelDM rO <br /> Grout Inspection By Dale PECIAL Well Permit <br /> Pump Inspection By Dale WAIVER Received <br /> Sol Boring Inspection By Date Constructed Well Depth R <br /> COMMENTS <br /> PE SC Received Chef Amount Wb PemIIV Invoke# Ws111DR <br /> Codas ]nib B Remitted <br /> Service Request# <br /> 3G l0 71 <br /> EM�3a8 WELLRUMPPERMR <br /> ¢NI,a8 <br />