Laserfiche WebLink
APR/1,9/2017/WED 02:46 PM <br />FAX No, �y,��aj gon 1{ qjn hA2 <br />17 <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1eGBEASTHA-'ELTONAVENUE-STOOi(TONCABB2OS-(209)458,341,0 <br />LeJt11111; Y41117I 1* E <br />EXPIRES 1 YEAR FROM DATE 16GUED <br />ADDRESS 23S00'KAccnn <br />Rond CITY/ZIP Trow ,Q,2](i <br />me STREET Mancuso R02Ct._ <br />APN 239-120-01 PARCEL 8gE7604c LANG USE APPLICATIONS <br />eR NAME Stare of rapfnrnla <br />PHONE <br />SER ADDR E89 <br />CITVISTgTk/XlP <br />TRACTOR V&W Drilling <br />ten. PHONE <br />TRACTOR ADDRS55 � fj-_�I(`IC <br />�'CA�}f.f�PIVR CITY/9TATE(ZIPStockton CA 9521.ri <br />:ONTRAOTOR <br />PMOAle <br />ADDREd3 CITY/STATPJZIP <br />a7 0-61 D-09 other NUI4BI R 720904 EXPIRATION DATE 04/30/2018 <br />GEOGRAPHICAL INFORMATION: Coordingtes X (1, a ,7,7389) Y (1 cLng -12-'%6j�wnahlp_ Range Section <br />INTENDED USE OomaeedPrivate Imgellon/Agrlcuttumt Indvslrlal . Water Quality Monitoring X Stoll 9gmplbglOhRmcterl7.atlon <br />' Public Water 9ystom <br />B 011krant hom Onnee a r em ame on au amx or o u cr <br />vP� Ncw W.II r Raplecomnt Wall Well A1leratlonfModincation I Other <br />Monitoring Wcll(c) # ofwulla 8o9 Uolltig(e) Aofw6I,0. X @aotochnlcel FiVA ,_k <br />Out•Of-SerAce Well Out-OfServlce Well RanoAul Croee-Conneolion Rapai( <br />Now Pump PLIMp Replacement Pump Repair Relse Well Caeino <br />Drilling Method XMud Rotary Air Rotary X Auger Cablo Tool Puah Point X Olhor Hollow stem <br />Proposed We11 Depth 'Jn_,rj�I, Exc -Iflon Fr„_1(1„ In d1wotor , Open Bottom Graval Pp,*G avul Sino NA .In ellemelor <br />Conductor Cosfng _NA In diameter f Conductor Casing Depth NA R <br />Well Geeing DlameterNAIn ThtclineYfGaugolABTM ached NA - Stool Phslio - Staln)969 -tool Other <br />2rou1. Seal Deplh_2(],_�_It XNcat Comenl r94 fh bsy5-10 gel wafer) Sand Cement seek mfx/7 gal wator <br />Bentonite (20% solids) Othor <br />Orout Plaoament Method Pum ed Pon Fall vOthQr Rete rdenl / Accelorator (namo) <br />pFCwzl. Inefalled By Driller Pumpsorfreetor ii7Tjjr <br />_ Concrete Pedcawf Dimemlp s: Width It Le npTl�ft Thick_ In Ghrloty Box Stove PIDo <br />Z= ' SubmersibW Turbinc qlhiir HP Pump Bet,it Standing Wolof Level ft <br />I HEREBY CERTIFY THAT1 AVE PREP D THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY GROIN ES, STA WS, AND RULES AND REOULATION6, I ALSO CERTIFY THAT MY RROUIRED LICENSE IS <br />CURRENT AND TIVE WITIk THE 0AIJ90RNIA CONTRACTORS 6TATC OCENOE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKER& COM N6 ATION LAIVS. <br />1 fVj 24 D r iV071GE REQUIRED LF9 t7N5r- PL 209rDATE 9$�� 6771 f� <br />8lowea <br />EP I R T M 2 N TW E NLY <br />Appllmtlon Accoptod By Dole Area 'cv 1 Employed IDdi��� <br />Grout Inspection Py Dote SPECIAL WAIT Perrnff <br />Pump InapecBon By A Dow WAIVER Received <br />Boll Boring Inapecilon By AW d~)'y” rIYL Data j` ZZ- Conr:tructed Well Depth ft <br />COMMENTG <br />PE SO Aquolved checkof <br />Codea Info BV Cash <br />Amount Date efm V Involce fl <br />Ramlttad Service Request k <br />Well ID# <br />9-0 614E AC <br />hff!f�ii� 7,3', S <br />003 53 <br />EHD 43-05 <br />4rzwtz <br />Received Time Apr.19, 2017 2:48PM No.1284 <br />WELL /PUMP PERMIT <br />PAYf�gENT <br />REGElVLrD <br />� <br />PRQ1 9 2017 <br />HEg /Al Co <br />OfPg',� �4L <br />