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PA <br />APR <br />SAN JvH <br />FtNF <br />KALV <br />BI0 dy auliil ID;Aiaaa� <br />WELL/PUMP PERMIT <br />SAN.IOAOuIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTnN AVENUE- STO CTOTON CA 952D5 - (269)488-3Q O <br />r <br />rt <br />ADDRESS <br />ain <br />5w,EETNew Water RD A <br />NAmE JIm Wunderlich <br />ADo,,�-6932. E Main St <br />CONTRACMR Purviance grillers, Inc <br />CONTRACTOR ADOREPO Bog 64 <br />SuaCONTRACTOR <br />SUBCONTRACTOR ADDRE93 <br />UcEmrz -X 051 a C-61 <br />J D-09 u <br />EC71ONS EXPIRES 7 YEAR FROM DATE ISSUED <br />_ c,,,.%z,, �S� t o c k t c n CA 95215 <br />tCEL SQEQ VLAMI USE AQPLr Marj i! <br />P,,,WD9-403-1547 <br />CrTvrSrATEOP S t o c k t o Ti C A 9 5 2 15 <br />PHONE 209-887-3554 <br />CrivISTATEMPLiRden, CA 95236 <br />CRYISTATEMP <br />NUMBER E mRA7lzm <br />DamEBTir-WELLSAmpubcs: Li General MinerallColiform Bacteria (4391) F Dibrnmohloropropane (4392) Arsenic (4393) <br />NTFINOED Us E Domesfc/Privale 0 Inigation/AgricvRuraJ C industrial [--Water Quality Monitoring O Sail Sampling/Charadedmion <br />D Pubic Water System <br />Irffidemra from Owner. WderSlstem Name CoMad Name ar Ptgne Nemtt, <br />TYPE OF WORK 0 New Well C Replacement Well C I/Vell AlterationfModifieation 0 Other <br />11 Monitoring Wells) #cfwPlls r, Soil Bodng(s) 1rarbwrra5 n Geolechnicai aofnorirgs <br />0 Out -0f -service VMj r Out-CfServioe Welt Renewal 0 Cross-Connectian Repair o' <br />Drilling Method O Mud Rotary C Air Rotary n Auger n Cable Tool O Push Point O Oiher <br />Proposed Well Depth fl Excavation m diameter D Open Bottom C Gravel PackJGravel Size In diameter <br />D Conductor Casing h dremeler I Conductor Casing Depth R <br />Well Casing Diameter_ in Th1cImesslGauSWASTM Sched 'u Steel 0 Plastic O Stainless Steel 0 Other <br />Grout Seal Depth ft 0 Neal Cernent (94 ib bag,5-10 gal water) .3 Sand Cement Sack MWT gal ureter <br />C Bentonite (20% solids} 0 Other <br />Grout Placement Method C Pumped D Free Fall O Other C RatadanIfAccelertor (name) <br />PEDESFAL Installed By 0 Otiller U Pump CoMrsctor U Other <br />❑ Concrete Pedestal 11Dimensions:Width R Length n ThicN in D Ctvisty Box rl Stove Prpe <br />PUMP 0 SubmersihleD Turbine 3 Other HP Pump Set 7 r6 ft Standing Wafer Level R <br />I HEREBY CERTIFY THAT t NAVE 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 PAY REQUIRED LICENSE IS <br />CSD ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />MINI M 24 H V E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />S1r - T„,�orporate Secretar&, <br />P <br />Application Accepted BY <br />Groul Inspection By <br />Pump lnspect on By <br />Soil Boring Inspection By <br />COMMENTS <br />TMENT Upc 1N Y <br />Date -f O <br />Date <br />Date <br />Date <br />gam �� <br />Area� � Employee ID*M (2—/ <br />SPECIAL Weli Permit <br />0 WAIvERReceived <br />Constructed Well Depth ft <br />B10 /J -0e BT11116 �-�[/ v �%%t3470�7 IM1RLL1Plfr[P PER I6ET <br />N <br />Em <br />a <br />v <br />p <br />C= <br />CIO <br />X <br />M <br />0 <br />M <br />ram <br />C <br />M <br />0 <br />Z -d VZ9U9960Z OUB SlaIIi.lQ aOUeiAind d L:�O 9 L V01dd <br />