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9860'ON Wdti8:9 9l0l '8l 'l1r I W I PIAiaaay <br />WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY aWtOTIMENTAL REALTw DePARTNENr '1a68 EA$rF1AZt3TCN AVwuE-STaorroN CA 95205 - 120914683420 <br />FOR lt4saeCnors EXPIRES 9 YEAR. FR0?d DATE ISSUEo <br />ADDRESS <br />9942 Copperopolois <br />Rd <br />C.1TazFStockton 5[5215 <br />ss s,pme, S <br />Patrick <br />APN 1 32 (1 <br />DF> ` PpRCFLS—r, t LAND u5E,1PPUU,T„N a <br />IERNAMZ MTS <br />_ IV l (' k P P P <br />Y f- i <br />PHONIP n q—Q /41i <br />IERADDRESS <br />9942 E Copperopolis Rd <br />CnYISTATE-"-,-�tnrkt•nn <br />TRACTOR <br />Purviance <br />Drillers, <br />Inc. pHA 209-887-3554 <br />rRACTM ADDRESS <br />P. O_ T3 o x <br />64 <br />tIFTYISTATFIZIP Linden, C A Q 5 2 3 <br />:CKTRACTmt <br />PlHOM <br />SuscONTRftcT(w A=REss <br />LJCENSE LJ C-57 L, C-61 L! 10-09 _ <br />C nvlSraTVZ P <br />,u. 377923 <br />EXPIRATION DATE 7/31/17 <br />VCt mAm Gl j)a aNATroi4: uacrotnates x Y Township _ Range Section <br />INTENDED us 7 Dorn Sr10" to I' <br />%mrd / ntgat PAgnallural a Industrial _ WeteraualityMoniloring 7 Sat Sampling/CharaCeAz2Nan <br />1! P01 1c Water System <br />It dlSer9nl Nvm Ownm: er ya,em o me or rt <br />TYPE OF WORX : Ne v VWX _ Replacement Wel U Well AlteraliontModifica9en _ Other <br />ManitcdngWett{s1 :Of wells 50.1Bodng(sJ o0160"a` ; Gaoter3mical scroaMgs <br />Cut -01 -Service Vulell Out-O"ervice WW Renm al . Crass -Connection Repair <br />New Purnp IN Pump Replacement C PumD Repair , Qom;_ :nen ra.:.... <br />Drilling Method _ Mud Rotary Air Rotary J Auger L Cable Tool A Push Point Othre <br />Proposed Well DepUl ftExcavation in diameter Open Bottom c Gravel PaddGravel Size in diametcr <br />Conductor Casing in diameter I CorlductorCasing Depth ft <br />WOU Casing Diameter_ in Tnidtness)GaugPJASTM Sched _Steel T Plaslic Z Slainless Sleel C Other <br />Grout Seal Depth R -2 Neal Cement (94 1b bag05-70ga! vaterj = Sand Cement sack tr.W7 gal urdter <br />Bentonite (26%50kI&) , : Other , <br />Grout Placement Method _ Pumped _ Free Fall = Other 7 Retardant IA=eierator (nzmel <br />P®t srAL Installed By _ Onller - Pump CcnV=arC Other <br />Concrete Pedestal _D(mansions: Yldlh It Length R 1-mclt in t t Chraty Box Stove Pipe <br />u Submersible/Turbine it Other HP Pump Sel R Standing Water Lewl _ R <br />1In HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WALL BE CONE IN ACCORDANCE WITH SAN <br />--- <br />DEPARTMENT USE ONLY <br />2 <br />AppiicrioO Accepted By c Date -A-- �b <br />Grout Inspection By Date <br />Pump Inspection By Date <br />ScA Boring L-lspesIIon BY Dale <br />PE SC <br />Codes Info <br />I S A-- <br />tLSUH60Z <br />omitted Date <br />EWE <br />1 � 2010 <br />ENTAL HEALTF <br />'ISERVRCES <br />Area Employee 00 4- 5'L6 `� <br />!J sPECIALWellPermtt "fAA MENT <br />• WAIVER Received RECEIVED <br />Constructed Well Depth <br />�� H'rn� �s� A 5.4 t 04( %jIN G`OUNTY <br />#Invoice# w VI OMENTAL <br />►dMV37�b�l f Ep�ArrrlENT <br />�4 el,l /PUAii AERHttr <br />01_11 S_1811!Ja e0Ue1Aand eft: �0 ZO 9l qe_� <br />