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WELL J PUMP PERMIT <br /> 600 E.An, '%tmN'Srxm-STOCKTON'CA 93202-(2M 468-3420 <br /> WON-REFUNDABLE PEWNHT EXPIRES I YEAR FROST DATE ISSVED <br /> ION AIJOHI 1.4 -OR�16/ <br /> CROSSSTREEr S HEI It'-' PA 2 <br /> All 0 <br /> OW_NE:RN.%%O: <br /> O'r�a_S (oid <br /> CITYiSTATEMP----6r4 <br /> Ofr <br /> CD%rRICFOR (I <br /> Z-Zqqn <br /> CO%1R,.(7TORAl)i3RE&s.__L0MA S_.A±ijY_ __ Ctii,SrAyEMP K_ <br /> SUISCONTMIXTOR <br /> SUNCONTRAC fOR ADDRESS <br /> Cip JST,%jEj7 <br /> LICENSE 0 C-57 NET, 11 D_09 0 Oftr <br /> GEOG%i,PujcALJNFoP_At.mo%-. Coordinates X Range- Section-- <br /> MDommic;Privaic )W&ption,Agricultural M industrial 0 Water Quatil)'Momoring E3 Sail Saraptinge.0taacterizadon <br /> Ll Public Wak-Ststant <br /> Genz.,Na P* <br /> TYPE OFWORK oxwWall 0 Replacement WM C1 Well Aft.raicruMlodfficallor 0 1c9 Mol- 13 Other <br /> 0 monitoring Well(s) 13Soil BorinZs)_ 0Geotcbn!rL,1_ <br /> 0 Well lkstrucdon E3 0ui.0f.S,;r%ic0 Wzl, M Out-Of-Scn ice Well Renewal <br /> "�.-e-A Pump 0 Pury lierplacenicat. 0 Purnp R. it Cl Cross-Connection Repair <br /> WIELLCONSTRL-1710N <br /> Drilling Method 13 Mad Rotary C3 Air Rouiry 0 Auger Cl Cable Toot C3 Push Point 0 Cthar <br /> Proposed Well f' Excavation in dianiete 0 Open Bottom M Gya%el Pack,Gravel Size in diameter <br /> OConductor Ca.ing_indiameter I Conductor Casing Depth-ft <br /> NNW Casing Diarneltr-in Thickms�!Gaugc.,ASTMSchell__ OS,.czl OPlastic 0 Siainlc,-,Steel 0 Other. <br /> Grout Seal DTth--A 13\,atCctmrt:94161,ag.';-/Oga!Amer; 0 Sand C:m;mz sack wbc,7 L-A water <br /> 0 Sentomic f 2if,e solids.! asr-csonFila IMSpecs submitted <br /> Groat Mmirment.Metbod CIPumped OFree Fall Cl Other <br /> PEDESYAL 1111198M BY 0!hirer 0 Pump coutrair.or 13("--r <br /> D Concrete pedestal Dimensions: Width-ft Lmedt-I! Thick ...in C3 Christi BOT ustmePipe <br /> Pump 'P-%bn:emMc ri)&ybine []Other- HP 'Zja PurnpSzt <br /> AVf -j <br /> 2,7 j <br /> WELLD1,STRUCHON 0 Open Honm 0 Gravel Pick L-3 Unca rd DMcr---- <br /> Well DiamLr-in Total Depth---ti Depth to'A'ater____A 0 C:simg to be Peribrawd froni__fi 10__ft <br /> Sealing-Material Cl Nicat Cement e94 1b bag:5-10g-ai cater) 0 14nd.Ccm-,nl--,-,,ack mL-i 7 gal v%aref 0 Bentonite Pallets <br /> 0 Hentonit,i20%solids) 0 Mitnufactumr Spcc%solids__11; Name OSp-ss onFil: DSmc�;Subtnirtcd <br /> Placement.Method 0 Purnpcd 0 Free Fail 13 Other <br /> C3 Conipk-W x ith M- usbuo-itin Cap--ft below 2m& 0 Compizze to Existing SurUcc Pad <br /> T HEREBY CEPTIF"THAT I HAVE PREPARED THJ$APPLICATION AND THA:1 THE WORK W11.1,BE DONE Vq ACCORDANCE WITH SAN <br /> JOAQUri COUNTY ORDINNINCES, STATE LAWS.AND RULES A.ND REGULATIONS. 1 ALSO CFRTHFV THAT MY REQUIRED LICENSE IS <br /> CURRENT AND CT ALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM LN COMPLIANCE WITH ALL <br /> m <br /> TITLE. IA-11: C3 <br /> _ -/=--L7 M;0 C-) <br /> C')m: <br /> m <br /> PAYMENT <br /> -4 <br /> EC <br /> EW-ED <br /> wul - Uiji <br /> 2017 <br /> N J0AQUIN COUNTY <br /> ENT <br /> DEPAR" 11 <br /> B, WUSE rY <br /> AppUcinionAmpmd Al� D. A. <br /> Grz-ut I . B 7 <br /> nspeclion Date SPECIAL Well Permit <br /> ,.-T lo .con By 0.,c E3 WAIVER R.611d <br /> Destruction inspection By---- Dan; Constructed WeR Depth_.-ft <br /> COMMENIS <br /> PE Sc Reediiad Checkw Amm"t Date Flffmw Invokeill Well IDN <br /> Cada Info CMA RCS Date am# <br /> e <br /> 650 <br /> TT - <br /> EM 43-02-M WEB :!'ell Perm and Decbr3dm doc <br /> 9111]:ZW7 <br />