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05/20/2013 03:07 2094661324 <br />■ <br />�■■� 19764 <br />.: SMJ6AAtJN COtf M ENYIRON%ENTALRE>;ALTk 000 <br />DELTA PUMP <br />PAGE 01/01 <br />WELLIPUMP PERMIT <br />1858 east Herstton Avenue • 8Toc+To9 CA 96' 0842k - '(209) 40.3420 <br />UL (2091963-7691 FOR INSPECTION$ EXPIR581 YeAtz FrRa t DA rr Is urn <br />JosAoma6 15420 E. St',. ETt 4 CITYA.np._-.AMCKWN 252.35 ,. <br />Ck2086'STrif9T . A( ^ I i -Oli �PARVNL. MV-320—LiWD USSAPPIXATION# <br />OWNUR NAM? -TD 7N;_ I Mda _ P80NE 601-2069 <br />Ov`iNgR ADDRl=8s 145500 HWY 4. Ct'rYiswamp S TOCKTON CA 9 5 21 <br />COTdTf�'diCTOR 1 SCTd=MN ARMATi;IR4 �MQT @MRK <br />CormtActon'ADDieesa 646 S. Csalfornia Street 0nJ5T.ATEZP Stocktron. CA 95203 <br />R NON <br />n, Ansn Ct't'K11Q1'per21Z►t+ <br />X87 90-61 0 D-09 0 0111er - - -_ NUMM. �.�.. (a"M Ano(4 t)Aw 0 V � r�, 7; -- <br />©E0QWMtCAL. (HKRAMAMN: Coordinateo X Y T*Nnship Range BecMon. <br />INx ntnso llsa 0 OomesHdPrfvataXk frdgallon/Agricultural 0 InduaWat ❑ Water Quafity Monitnrtng 0 Soil Sampling/Chareaterlution <br />0 .PubRo Water;System <br />it difromnt from Owner, a <br />s OF M ❑ Now Vdeli d Replacement Melt 0 Wo(( Altet'aUon/Mod(@caWn 0 Other <br /># of <br />Er M4rt1tiNing Wall(S) of woo O SGfI $0I111�9} boAnos ('i C3900C1111k8/ 90100tictga <br />0 Oul.opservloe well q Out^OF-Z�Omce WOW Ran"I O Crosr�nnactlon Repair <br />Drilling Method ❑ Mud. Rotary �Ij Alf Rotary 0 Auger a Cable, Taol Q Push. Point - D Oth®r <br />Proposed Well Dbpth____,__,_ a EXfravation -—in diameter a 0p®n ®Dhotis q Graysi Pack (3revel 8lzA in diameter <br />0 Conductor Casing In diem®ter t CO►lductor CaalN: Da* <br />Web Casing Dlamatar In. Thickneasl©au elASTM Sohed._-.,-- <br />9 p Steel D P1estic O SWn)s8s: Steel tj .0thar_ <br />Oretwt Seat Depth tt O, -Meet cement (94 fb bst016'.lo pa(0 Sand Cam �eak.Mlxf7 gal water <br />'J �etlbonllo (2A%Za <br />O Qther <br />Grout Ptacesn®rk Method q pumrye I=ail a. Other O Retardant / Acaetera6or tame) <br />U. LARRa u rurnp uonrraaor O Other <br />499 taJ DImenNans: Width ft Len <br />-r w � on R "J!$tltl Weber l:A1%el ft <br />i HERERY CERTIFY THAT 1 .HAVE PREPARED THiS APKJOATiON AND THAT THE WORK WU.L Br' DONE (N ACCORDAIq= Wli?j 4AN <br />JOAQUIN COUNTY ORDWANCES, STATE LAWS, AND RUL96 ANO REGULATIONS. I ALSO Ctrt@TWy THAT A?Y'REQUIR0,IJCENSM IS <br />CURRENT R, AND ACTIVE WITId THE' CA�tPt�tZIYIA G"r1NTRACTO} <br />WORI'C'13R3 CQMF'EMSATIOiV.L,�ltA/9, <br />%4 8)rATR LICENSE iROARD A40 'i OAT I AM tN COMPLIANCE WITH AU. <br />24 MOOR ADVAN01 NOTfdE I" QUiR'ED FOP MSPECTIONS <br />DEPARTMENT US r; ONLY <br />'APp>fe2�liort Accap't�d By <br />(;rout-tnspscllon By Date <br />PUM ( Dat® <br />P na�ieoilon By Date <br />-9011,80"m (n apecuon sy. <br />?GMA7ENT8 Date, <br />Atea�� EnlpioyeQlCNI< - <br />SPECIAL W011, RAr Mft <br />WAIVER kftelved <br />•Cbnstrdate ( Weft DAp <br />WELL. fPUAtp MaMrr <br />Rproivpr Timp nrt lA 9(117 11-(11AM Nn 9AF� <br />