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Mr 01/04/2013 23:32 2094661324 DELTA PUMP PAGE 01/01 <br />�, 19487 WELLIPUMP PERMIT <br />SF N JOAQUINZbUNTY ENVIRONMENTAL HEALTH DRPT 1866 Esst'Hazelton AVenu6-- SThet(TON CA9S205-$292 - (209) 4$8.1420 <br />NON-REFUNDABLE PERMIT CALL 09 963-7607 FOR INSPECnONS rzXPlRES 1 YEAR mom. DATE ISSuEO <br />T <br />Jos ADDResa 20249 .G - T AMMER C RD - _ CITY/ZIP 'RACY 25394 9 <br />CROSS 9Tr2f4ST bIF9'oDJpiT1 DLE_ RD - APnr2 0 9 —2 g — Q _�, _PAZCeL S09 4 0 _ Q2AND VA5 APPUCArM # ��qq <br />!X <br />OVJNEttiJAMfn MARK ORNALLES PHONE209 642Z627 <br />OWNERADARFSs ---SAME _._ _ _ CI"STATPJZIP <br />CONTRACTOR T?��.tEL Pm.W a=CXTf]_N ARMATURE A. MOTOR_ WORKS U6Q., 2Q2-466-9-62,5— <br />CONTRACTOR ADDRws <br />Q2-46x6X62,5CONTRACTORADDRE6s 646 S. Califoxm.a Street CITY/STATVZIP Stocltt:on, CA 95203 <br />SUBCONTRACTOR <br />ei1Ji3QOf1iR'FICTOtt Astst22a9 <br />LICENSE C ir-67 X C-61 0 D-09 ❑ <br />PHONE <br />CISYJ�u'rgTC'JZtP r y <br />NUMBER EXPIRATION DATE 081' 1 1 <br />GsogRAPMIChL1NroRMATIONt Coordinates X Y _ TownshfA - Ranas . Section <br />tNTEntgf�p IJ$E 0 Domesac(PrIvate 0 Irrigation/Agricultural 0 Induetrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterizatlon <br />Q Pubfic Water System. <br />If dlf/efent(rom Oki et: a r amsNome or er <br />.LLr4�!r "Ljr + U. ivew vvell ❑ Keplaoement well 0 W611 AlteratioNModiffoatfon d, Other <br />O sorin�(), ❑ GeOteChifcarG tvonitoing Nel(s,_#of)vvls 0f�olborfr�gs <br />S� Out -4f -Service Well a Out -Of -Service Nall Renewal 0 Cross -Connection Repair <br />Dr111ing Method 0 Mud Rotary G Air Rotary. C, Auger ❑ Cable Tool ❑ Push Point Q Other <br />Proposed Well Npth ft Excavation in diameter ❑ Open Bottom D Gravel Pack/Gr4vel Slze In diameter <br />❑ Conductor Casing in diameter / Conductor Casing. Depth ft <br />Well c9sing DismeterIn. Thlckneas/GaugafASTM Schad 0 Steel 0 pfastic 0 Stalniesa Steel b Other <br />Grout Se$I 'Depth_f( <br />f( Cl Neat Cement (94 lb bao-10 gal water C Sand Cemern sack mlxl7 gal water <br />6entnri+ta (?A°A solids Q ether <br />Crout.Nacemen; Method O Pumped 0 Free Fall a. Other n Retardant I Accelerator (Remo) <br />Installed By 0 Driller ❑ Pump Contractor n Other <br />D Concrete Pedeetal'Dimensions: Width tt Longth 0 Thick in Q Chrleaty Box 0 Stove <br />lrl= ubmersfbleq Turbine C Other HP Pump Se R Standing. Water i svel ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATfON AND THAT THE WORK WILL OF- DONE IN ACCORDANCE WrrH SAN <br />JOAQUIN COUNTY ORDINANCESSTATE LAWS, AND RULES AND -REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE is <br />CURRENT AND ACTIVt~ WITht THE CALIFORNIA CONTRACTOtZa STATE LICgN6E BOARD AND TftAT.I AM IN COMPUANCE WITH ALL <br />WORKERS CompEN9A1,10N LAWS; <br />MINIM .M 24 HOUR ADVANCE NOTICE'REQUIRED FOR INSPECTIONS <br />jk <br />Tmt CEO <br />NOTE: THIS WAS AN EMERGENCY ISSUE OF NO WATER <br />TO THE HOME. WE HAD TO PULL. THE PUMP PRIOR TO YOU <br />RECEIVING THIS APPLICATION. <br />AND . <br />Louise Fornos <br />_.Office <br />Manager__-- <br />f5ATt81'2 zZWJ <br />