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WELUPUMP PERMIT <br />SAN .IOAotm COUNTY EwnnowrENTAL HEALTH DEPARTMENT <br />IDBS EAST HAZZLToN Avwwm - STOCKTON CA N3205 . (201) 4LS .3420 <br />NON-REFUNDABLE PERWY CALL (249) 953-7697 <br />FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />IJoeADORES* 12DO Humphreys Ct (Port of Stockton) <br />Ci7Y/Zv Stockton, 95203 <br />CRO" STRUT Navy Drive ApH _16203007 <br />PARCEL SUR 1372 LANG UsE ^mgxAnoN N <br />OWN" NAM Port of Stockton � <br />PHONE 209: 946-0246 <br />OWN" Amws 1047 cls 2 G l''q <br />CmrauTF/ZV Stockton, CA 95201 <br />CONTxACTM Kleinfelder Inc. <br />PHONE (209) 948-1345 <br />CnNrRACTOR AOoftm 2001 Arch Airport Road, Suite 100 <br />ClYtSTA1671 Stockton, CA 95206 <br />SUNCONTtACTOR Woodward Drill�ComaprtyInc. _ <br />PHONE (707) 374-4300 <br />suecowxxmot moons 550 River Road <br />CrTYtSTATTIUP Rio Vista, CA 94571 <br />LtcErree x Gal C-61 D-011 r. ovor <br />Ntlta " 710079 ErveMTION DATE 07/31/2019 <br />GEooRApmcAL ImFo AATTON: Coordlnebe X _-. _. Y <br />_. Township ._._ Rat ge, Section <br />ed <br />kmmpuSiu DomeakIF'rNale ' kr obordAgricukmvl WKkAt lal <br />W.w--- — <br />a,wEy MONbring It sol _ <br />Public W aler Sy.t.rr <br />v *4—fb—Ou+r <br />Tyn Or Wo" NOW Wel RepiecertwrN Wed Wall AharadoNMoliftsWn <br />00W <br />hlortibrir g W el(s N O(weft Sol Bori4e) <br />.._ N d bw X C-006actw)" 1 I of bOV" <br />Out.OfSrvice WOO Out-Of-Servbe WM Rsnevjw Cro"-C vection Repair <br />Drilling Method X Mud Rotary Air Rotary Auer Cable Tod Push PO" Ottwr <br />Proposed Wall Depth 70 rt EAcarWYon 4'' In di.nwtr Open BOfbm Gravel Padk/Gnwl Stan in diarrwor <br />Conductor Casing in dirnel r i Conductor Casrq Depth R <br />Wall CaekV DlenwW in Thickro"J , ASTM Schad Sled ;-I Ptncc StaVi"S Slid Other <br />Grant real Depth R N Neel Crrwnl ('W b bog --10 gar waNr) Sand C rrWA sack mbd7 9N waW <br />Bwtmk (20% solids) Other. <br />Grout PlaernrN Method X Pumped Free FM Other RalardrX Accelerator (learn) <br />PEDESTAL kweNMd By n DOW Pump corMrsetor Other <br />Concrete Pedeetel L Dkironaforr. WkNh _ It rt Thick h Christy Box stow Pepe <br />Imat Submrdble Turbhw 011ier HP Punp set rt Sl n&N wmw Level _ R <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN LOUNr ORP.'N-AX'ES, STATE LAWS, AND RULE3 AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE 15 <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONMACF& S STATE LlCFNSE BOARD AND THAT I AM W COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MItAM1UM 24 HOUR ADVA CEN TICSUIRED PEC NS - PLEASE CALL (209) 953-7697 <br />R <br />3§ <br />I <br />�DERTMENT�UY7iON Y 2,t <br />��,{,- � <br />MPYcaYon A—pld W � Ar.e!� L Emp+O,,.. Ion <br />Grout tnspeclion By / DOW ❑ EC1A1 Wfll Permit <br />Pump inp"on By _ DWA ^ WAIVER Received <br />Sol Boring krepectfon By Deis Conabuctod Wel Depth h <br />COMMENTS <br />PE >k PAC Med CheckWI1p Amowrt Pe -- <br />Cod" CCashh <br />CodRernilMd��M >lervlce RR / / WON IDN <br />ro•1 . rf'-i, <br />0000 WELL PUMP nxasT <br />~2 <br />