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Feb 23 02 01:03a Purviance Drillers Inc <br />2098873574 P.9 ,? <br />LA t+wk SL" '7-1716 Oyu <br />WELLIPUMP PERMIT <br />SAN JOAOU:N COUNTY ErrmmommEnTAL HEALTH DEPARTMENT 1858 FAST HAz.E..TaN AvEmuE-STaCK1CN CA952D5 - (2019) 4584420 <br />JN-KEFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />BADDREss 3151 .Tanae� marn Rd Q,z, Stockton ~CA 95205 <br />PARCELS <br />owSrREET Hwv 26 _APN RE UWDLSEAPPIJCATtang <br />INERNAME Dr Gerold Tanson _ PnoNE209-401-7690 <br />iNERADDRESS 3151 Tangemen Rd _ C.YSTATEiZIP Stockton CA 95205 <br />trRACTOR Purviance Drillers, Inc_ PkatlE 209-887-3554 <br />hwAcTOR ADDREss P. 0. T3O x 64 CTIYISTATE01, Linden, CA 95231 <br />SCONTRACTOR <br />BCOMTAAcTOR ADDP,Ess <br />ENSE a C-57 C-61 , D-09 <br />Pmwm <br />CIT7SrATEMP <br />NuMeen 377923 E ,,RATIaN <br />7/31 /17 <br />GEor.nAPHicALMroRtr.AnoN_ CoordinatesX Y Township Range Section_ <br />VVICED ME L] DomexCrlPrivate * lmgalion/Agricalhual G Industrial _ WaterQudiryMonitoring n Soil SemplinDfGhararlmizaWn <br />I! Public Water System <br />It CtEemrl tram Purer n ys ern .me — — ar Ph.1w N— <br />I YlAr <br />urnner <br />TYPE OF WORK L NeWVVel1 L Replacement Well a Well AKeratonrModifiration '� Other <br />I MonitoringWell(0. #aTvrels i, 5dlBaring(s) Aatbntiws - Geoteclnlcal PWbulj` <br />!1 Out-Of-Sumce Weld f' Out -Of -Service Well Renewal r Cross -Connection Repair <br />Orilling Method a Mud Rotary Air Rotary –t Auger a Cable Tool : Push Point .-! Other <br />Proposed Well Oepth R Excavation in diameter Ope i Batton G Gravel PacklGraval Size in diameters <br />_ConduclorCasafg in diameter ! Conductor Casing Depth ft <br />Well Casfng Diameter_ in Thickness/Gauae/ASTM Sched C Steel [I Plastic C Stainless Steel C Other <br />Grout Seal Depth fl J Neat Cement (941b bagrS-10gaf water] 7 Sand Cement sack mbdir gal tracer <br />i'. Bentonite(20%solids) _Other <br />Grout Placement We thud C Pumped Free Fall C Other r; Retardant I Accderdtar (name) <br />PEDESTAL Installed By = Dnller '7 Pump Contractor G Other <br />Lj Concrete Pedestal _Dimensions: Width it Length RTh)cc in i i Christy Boz L' Stave Pipe <br />PUMP A Submersibleu Turbine ; f Other HP % 5 Pump Sea R Standing Vater Level / O R <br />I HERESY CERTIFY THAT 1 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. t 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 />W COMPCNSATION LAWS. <br />MI UM O A ANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 <br />tGN E7 �, T,TIE Corporate Secreta,;gy <br />0 <br />F <br />I <br />�a 2016 <br />■■N!!■■!■SI■■J■■■■■:iii ■�J■■■■■!■■■■!!!!■■!■■i:�ili' <br />■■®■■■■■■■■■■■■■■■Ili ■��7■■■■!■■■!■■■■■■■■■■■ <br />■■■■■■■!■■■■■■■■■■■■■■�i�■■■■■■■■■■i■i■■■!■■/! <br />■■■■■■■■■■■■■■■■■■■N ■■■■■■■■■ice■■�l�llL7�/■■■■■ • <br />lt���rr_.�r_ ��•��r�.ail�tt�tatat� -- <br />■■■■■■■■!■i■■�■�■■�■■■■■■■■■■�!■■■■■■■■i■f■04 er <br />Application Accepted By ICate A. 4 Employee 1139�. <br />GrDut;nspection BV Date :3 SPECIAL Well Permit <br />Pump Inspection Ely Date L/I I I D WwER Received <br />Sail Boring In y Date Constructed We!! Depth <br />PE SC Received Chec:w <br />Codes Info h <br />Amaun[ <br />Remltied <br />Date PestniU <br />Service nest <br />Irrvofce k VYett IDeN <br />d 5D <" <br />3 <br />7124iie SI2oo7s32o <br />WPM" <br />GME) 2 L.( - <br />4aX12 a /per"� <br />2 wFF:.LrrunsaPruerrrr <br />(� (�� <br />Received Time Jul, 25. 2016 5:52PM No. 1020 <br />