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20555 IIAI I_I PPUMP <br />PERMIT <br />SAN JOAO+UIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 7907 BATES RD. CITY2fP TRACY CA 95304 <br />CROSS STREET_ G1R H ART APN _248-23-024 PARCEL SIZE 1 . 4 9LAND USE APPLICATION # <br />OWNER NAME CYNTHIA BRIDGES PHONE 814-4751 <br />OWNERADDRESS SAME CITY/STATE/ZIP <br />CONTRACTOR Delta Pump 4TnC`KTn T ARMATTIRF & MOTnR WORKS f►i &-- 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITYISTATE/ZIP Stockton, CA 95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE ❑ C-57 X C-61 <br />D D-09 ❑ Other NUMBER <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK <br />Y <br />CITY/STATE/ZIP <br />PHONE <br />EXPIRATION DATE 08/11 <br />Township Range Section <br />L-)�mesnc/rrlvate ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization <br />0 Public Water System <br />If different from Owner: a er ys em amp Cvfilacf Name or Prione Numoer <br />❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification <br />D Monitoring Well(s) # of wells D Sol( Boring(s) <br />C Out -Of -Service Well 0 Out -Of -Service Well Renewal <br />❑ New Pump ❑ Pump Replacement CXRUmD Repair <br />0 Other <br /># of borings <br />❑ Geotechnical <br />❑ Cross -Connection Repair <br />0 Raise Well Casino <br />Drilling Method ElMud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool 0 Push Point 0 Other �IVI ('/ "UT <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom ❑Gravel PacWGrav�fl$tze; -UIN COUTyf7tljemeter <br />D Conductor Casing in diameter / Conductor Casing Depth ft HEAP 11 L <br />' <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad ❑Steel ❑Plastic ❑Stainless Steel D ODC�therr *rVENT <br />Grout Seat Depth ft C Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack mixl7 gal water <br />i Bentonite (20% solids) ❑ Other <br />Grout Placement Method 0 Pumped 0 Free Fall C Other ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft Length It Thick in 0 Christy Box C Stove Pipe <br />PUMP ubmersible❑ Turbine ❑ Other HP 1 . 5 Pump Set ft Standing Water Levelft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WIT_ H THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION <br />MINI UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED — 2�� TITLE CEO <br />DATE7/2/2� <br />- PUMP/WELL is located behind <br />--` wooden enclosure. See insert. <br />PA ME NT Up E 9 NLY <br />r <br />Application Accepted By <br />Date Area Employee ID#/� <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date C7 WAIVER Received <br />Soil Boring Inspection By <br />COMMENTS <br />PE SC Race <br />Codes Info g <br />Date <br />;hebk#/ <br />Amount <br />Permit/ <br />a <br />Remitted <br />Date Service Re u <br />Constructed Well Depth <br /># I Invoice # <br />Well ID# <br />ft <br />END 43.06 <br />8/04/08 WELL /PUMP PERMIT <br />1 <br />M <br />D <br />v <br />M <br />m <br />m <br />N <br />