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L l(, -I -ld 6E10 "N NS:6 9106 'W110 awil paAiaDa� ua%n L I _*w WELUPUMP PERMIT SAN J DAO UIN COUNTY ENVaiONMENrAL HEALTH DEPARTMENr 1868 EAST HA2ELTON AVENUE - STOCKTON CA 95205 - (209)469-342o NON-REFUNDABLE PERItnT CALL 209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRom DATE ISSUED JOB ADDRESS 23150 N Johnson RdCmZP Clements, CAgSZ2% CROSS STREET H w y 12 APN 023-280-08--- CEL S. 9, 3,k.. USE APPLICATION 311n[ER NAME Good Earth Farms PHONE209-601-61 2=6j0_1 -_61_1 L_ :)VVMM ADDR=175 Enterprize--Crt _ crrwsTATvzPCalt, CA 95632 'ONTRACTMPurviance Drillers, Inc. PiroNE 2(19-887-3554 :ONTRACTOR ADDRESS p- 0- R o x 64 C,TV,STATEMP_ U nd e n, CD, 9523 SUSCOMACToR ADDRess LlcevsE • C•57 _ C-61 _. D419 _ GEOGRAPHICAL IUFORMAMON: Coordinates X PRONE CITYISTATEOP NIPPER 371923 E: ... c Tw. nr[F1aDED UsE DomPublic water !r Irt galioNAyTicultural Induslrlal , WeterQuality Monitoring r. Soil SampliViGharacterizagan Public M from Oystem Co:fhrenr from Owner. avec ys em anr me or na umortr _.- _.- _ . -r ...-•........_. ., worr—rauornmoamcauen ;Monitoring VVeSI(s) iY of yells Sol Boring(a)ao/Eorirys Geotechnical t albwags Oul-of-Service Well OutsOFSerAce Well newai ^Crass -Conn tion Repair :.� New Pu L Pum R lacement 0 Pum Repair ^ Raise'Nell n WELL CONSTRUCTION IDrilling Method 0MudRotary _ Air Rotary Auge' Cable Tool _Push aint Other Proposed Well Deptr14D0 ft Excavation 2- In diameter f 0 Boltom = Grave PecidGravel Size in diameter J Conductor acing in diameter Conductor Casing Depth fi Well Casing Diameter in Thidmass GeugelASTM S _, 2 -SZ ,Steel O Plastic -Stainless Steel Other Grout Seat Depth 1004- ft D Neal Cement r94 bag/5-r0 gal wateh ! Sand C ent 14L 3 sack mix17 gat water Bentonite (20 % sob ds) i'i Other Grout Placement Method a Pumped :! Free Fall -_ Other C Retardan Accelerator (name) PME37AL Installed By _ Ddllet r Pump Contractor Other L Concrete Pedes Imensions: Width Length rt Thick in - Christy BOK U Stove Pipe PUMP _ SubmersibteL.. 74bine jc 1 1! Other Pump Set it Standing Water Level ft i I HEREBY CERTIFY THAT 1 HAU PR ABED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE JO OLIN COUNTY ORDINANCES, STA CU WITH SAN LAWS, AND RULES AND REGULATIONS_ t ALSO CERTIFY THAT MY REQUIRED LICENSE IS ENS AND ACTIVE WITH CA FORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH WO ERS COMPENSATION LAWS. ALL UNl CE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2050) 953-7697 SIGNS TILE Corporate Secrete 10/11/16 ; EPRTMENT SE O LY lv�/J Employee IDA Appgeallan Accepted ` Date 'read _ _I T� Grout Inspection By Date D SPECIAL Well Permit Pump Inspection Ey Date D WAIVER Received Soil Boring Inspection By Date Constructed Welt Oeptty tt . , /_ c 4)]692 WELLIPULP PERLVT Z d tL9£L9860Z out saelliaa eoueinand d 6006 ZO L L AeW mat'��t�N■■■\■■■■■■■■■■■■■S■■■■■■■■■N��t ®■■RENEE ■■■■■■■■1•\■■■■■■■EF1■■■■■■■■■■■�■■! ��., .' ■■■■i(�■■■■■■■■■■■■►'�■�■■ice!■■1■ • • • O■■■r■t'If■■■■■■■■O■■E■O�i�/N3■■O■ ■■■O■■■■■E■■■!!A■7nw, NONE ■■Nf!!!E SEEM O■■fl12016 iE!■■■E ■N■■■iNEE■■■■UMM12i MEN E■■■■■ iii" N■■EO2 • — ■ a■E■■■MIQE�i]►4� ■KOW a MEN■E■07i4 AL HF -4L7-8 ',TR NUMMIRMEME ■■■EN R■■E■t■■■■■■■■■■■■■nl�lIIIR,'l�11'>l�II NMI 10010 tWCES EEMEs�� EPRTMENT SE O LY lv�/J Employee IDA Appgeallan Accepted ` Date 'read _ _I T� Grout Inspection By Date D SPECIAL Well Permit Pump Inspection Ey Date D WAIVER Received Soil Boring Inspection By Date Constructed Welt Oeptty tt . , /_ c 4)]692 WELLIPULP PERLVT Z d tL9£L9860Z out saelliaa eoueinand d 6006 ZO L L AeW