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3 I J <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY E.RONNENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AvaNuE-S1OKi CA 95205-(209)468-8420 <br /> NON-REFUNDABL P RMIT CALL209 -7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB AppREBeftseftnrRmt7-L - Z� cmrmP Tracy,CA 95377 m <br /> n <br /> Laos STNFsr 'Grant Line Road ARCBL <br /> PN - PASME 20.24 LANDLU EAPPLICATI N/A <br /> YM <br /> OER NAME RYed.10ANA W-T f zTT tA.L PNONE (2091 481-9386 g <br /> OWNER AOOREss T24�0 Toyystee�Roadd _ cRYIsTATE2P Tracy,CA 95377 <br /> CONTRACTORi 4VL.{C17�y�iC PHONE <br /> CONTRACTOR AOaREB$�p)♦y.yy�wYYVpytyLyC C"ISTATERIP <br /> oN .TOR Krazan&Associates.Inc. PHONE (559)348-2200 <br /> SigiacoNTRAchor,AOOREss 215 West Dakota Avenue cmrrstrATagnip Clovis,CA 93612 <br /> LKENSE R C-57 U C-61 J D-09 _Other NUMBER 499908 EXPIRATION DAME 10/31/2018 <br /> GEOORAPHICALINFORMA OOrdImSQ,,x 37.75181-N y 121.46278-W Townshlp,2$_ RangeH Secdon1�L <br /> INM,u,M USE DomestielPdvete C Irrlgal ondAglleulWral C Industrial O Water Quailty Monitoring 0 Soil SemplinglChareetedeation <br /> Public Witter System <br /> Relanmi from Ower. contact N.ms or <br /> TWE OF WauL New Well -Replacement Well D Well ABeradoNL4odigca0pn R Other UeOteCtlq&al Ikvitstigation <br /> Monitoring WBfl(s) Sof Its SWIBedng(5) ae1i*RI KGeotechn(aI 2 Q <br /> _Out-ofServke Well Out-Of-Service Well Renewal O cros20 Sr 50' <br /> -New Pum - Pum R lacement n Pum art n Raise Well Casio <br /> wELLcoNsnwamox <br /> No s wz a lost e gust geotec ruc onngs,one to and one to <br /> Drilling Method -Mud Rotary Air Raley R Auger n Cable Tool ri push Point r Other <br /> Proposed Well Depth X EXcavaBon 7 in diameter J Open Bottom J Gravel Peck/Grevel Spa in diameter <br /> . Conductor Casing In diameter I Conductor Casing Depth it <br /> Well Casing Diameter_in ThicknessGaugelASTNIScheci J Slael 0 Plastic 0 Stainless Steel D Other <br /> Grout Seal Depthft W Neal Cement(9416 Wg/5.10 gal water) a Sand Cement sack mW gal water <br /> =Bentonite(20%solids) ❑OME, <br /> Groat Placement Method R Pumped DFree Fall 0Other ]Retardant/Accelerator(name) <br /> Pfigi Installed By LD4Iler UPump Contractor Other <br /> N/A 'Concrete Pedestal-Dimenslore.Widih fl Length-Snick In - Christy Be. -I Stora Pipe <br /> uLl N/A _SubnnmubleC Turbine C Ciher HP Pump Set ft Standing Water Level B <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. I ALSO CERTIFY THAT MY REQUIRED LICENSE Is <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIM�IM UR AN UIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> Sw r/ TTUB 'INRNA16at (�Aa6rwr DAM Z�fS�t'7 <br /> e e 46o I -ir gj a*d joqtajnjnj s il s s 4 of 4h g, ol e< x It: In e 1 a o a <br /> F�FOFMFNr <br /> 1. <br /> � Fo <br /> E?;�oF«es?oi� <br /> �P eAT <br /> DE ARTM ENT SE ONLY ,��...///���y// TT.�r{TT,u, <br /> Application Accepted eye Date U/1.17/1 L Araa Employee ID# V` <br /> Grout Inspection By trate TSI ❑ PECIAL ell Parl <br /> Pump Inspection By Data ❑ WAIVER Recelved <br /> Sal eating Inspection By Dale Constructed Well Depth ft <br /> COMTS <br /> 2 y rJs _ __ N 11-7 <br /> P Bas he Amount Data Perot Imroica0 Well IDM <br /> Codes Info Remlttad Service Repo estM <br /> z tqe SS 3► `4 1 Sv,c0t,7 �(apa12�2 <br /> i <br /> E.D.. ( AELL IPUW PERMIT <br /> NM2 <br />