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PQrC _ WELL/PUMP PERMIT annP— MAIN STREET -STOCKTONCA96202 - (209)468-3420 .,..voft-AAMON: conrelinafaaX Y Iownsnrp_ nww- — NTENDEO USE DomesliclPrivate Irdgatlon/Agricultural Industrial Water Quality Monitoring otl Sampling/Characterizauo Public Water System If di ferant from Owner. a r ys em NamE on ec ame or ne um er TYPE OF WORK New Well Replacement Well Well AlteraUOn/M6atncation vt— gofbodnga Geotechnical Aof bodega Monitodng Well(s) # of wells Soil Boring(s) - out -Of -Service We Oul-OfService Well Renewal Cross -Connection Repair Drilling Method cEd o Air Rotary u er Cable Tool Push Point Other Proposed Well Depth 30-80 ft Excavation 6 in diameter Open Bottom Gravel Pack/Gravel Size in diameter Conductor Casing in diameter / Conductor Casing Depth ft Walt Casing Diameter _ In Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other Grout Seal Depth ft Neat Cement (94 1b bag/5-10 gal water) Sand Cement sack rrixfl gal water BentanRe (23AjWgs) Other Grout Placement Method umped Free Fall Other Retardant/Accelerator(name) EDESTAL Installed By Driller Pump Contractor Other Concrete Pedestal! Dimensions: Width ft Length ftThick in Christy Box Stove Pipe u P Submersible Turbine Other HP Pump Set ft Standing Water Level _ft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSFf90ARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. ryK�_ _' //►,MINIM/UM X24%HOUR ADVANCE NOTIiE,-.REQUIRED FOR INSPECTIONS stcNEO I JWZ� �-^'�"'�X; 7t� Project Engineer DATE 1012/17 Application Accepted By Grout inspection By Pump Inspection By Soil Boring Inspection .a, � COMMENTS .Lt ■tri RENTUti9 O Y ��) Date 1t✓�/ Area Employee ID# W--� Date �l ° SPECIAL Well Permit Date WAIVER Received tuvu nnnrh ft A 0 C4 F" gZ d >N O U-1 ec' zMa 5zu! U C.;D a¢ r, W 05; 1J-- -z J !1. CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE SSUED NOWREFUNDAB PERMIT 5400, 6666, 6701 . Kile Rd Crrrl7jP Thomton / 95242 JOB ADDRESS N. Nowell Rd & N. Ray Rd AP _ PARCEL SIZE 166.8 LAND USE APPDCATION # CROSS STREET - s C1 l n r / MJ PHONE OWNER NAME '�.rF.lgg* I j 0� (� CITYISrATE/Lf'P L �^ - OWNER ADDRESS - CONTRACTOR Kleinfelder, Inc. PHONE __ 209-577-4333 CONTRACTOR ADDRESS 1224 6th Street Cm/STATEMP Modesto / CA / 95354 SUBCONTRACTOR PHONE 976-3/7-BT�A� SUBCONTRACTOR ADDRESS688 Sh CITY/STATEIZIP NUMBER't19�� CItPIRATION DATE Z / LICENSE C-57 C-61 D-09 Other .,..voft-AAMON: conrelinafaaX Y Iownsnrp_ nww- — NTENDEO USE DomesliclPrivate Irdgatlon/Agricultural Industrial Water Quality Monitoring otl Sampling/Characterizauo Public Water System If di ferant from Owner. a r ys em NamE on ec ame or ne um er TYPE OF WORK New Well Replacement Well Well AlteraUOn/M6atncation vt— gofbodnga Geotechnical Aof bodega Monitodng Well(s) # of wells Soil Boring(s) - out -Of -Service We Oul-OfService Well Renewal Cross -Connection Repair Drilling Method cEd o Air Rotary u er Cable Tool Push Point Other Proposed Well Depth 30-80 ft Excavation 6 in diameter Open Bottom Gravel Pack/Gravel Size in diameter Conductor Casing in diameter / Conductor Casing Depth ft Walt Casing Diameter _ In Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other Grout Seal Depth ft Neat Cement (94 1b bag/5-10 gal water) Sand Cement sack rrixfl gal water BentanRe (23AjWgs) Other Grout Placement Method umped Free Fall Other Retardant/Accelerator(name) EDESTAL Installed By Driller Pump Contractor Other Concrete Pedestal! Dimensions: Width ft Length ftThick in Christy Box Stove Pipe u P Submersible Turbine Other HP Pump Set ft Standing Water Level _ft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSFf90ARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. ryK�_ _' //►,MINIM/UM X24%HOUR ADVANCE NOTIiE,-.REQUIRED FOR INSPECTIONS stcNEO I JWZ� �-^'�"'�X; 7t� Project Engineer DATE 1012/17 Application Accepted By Grout inspection By Pump Inspection By Soil Boring Inspection .a, � COMMENTS .Lt ■tri RENTUti9 O Y ��) Date 1t✓�/ Area Employee ID# W--� Date �l ° SPECIAL Well Permit Date WAIVER Received tuvu nnnrh ft A 0 C4 F" gZ d >N O U-1 ec' zMa 5zu! U C.;D a¢ r, W 05; 1J-- -z J !1.