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�ZWIN M60 :: BIOZ ll 'Sny awll panla�a� <br /> • WELUPUMP PERMIT <br /> i SAN JOAouim Cc,UNTYEN0RONMENTALHEAL7H DEPARTTIENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468 420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> .IDB ADDRESS 2 3 0 0 1 N J h n R Clry*] f-m P-n t s D <br /> LZ+ass STREErE S t R t ({\,J 3r 12 APiY • fw -PARCEL USE APPL[CATWN.'{ 1 o <br /> P <br /> OWNER NAME Good Ear h l /�1ZM S PHoae?0 9—3 2 7—9 1 1 7 <br /> OWNER ADDRESS 1 7 5 E n t e r p r i z e C,TYJSTATE0P G a l t CA 95632 <br /> CONTRACTUR Purviance Drillers , Inc PHONE 209-887-3554 <br /> CONTRACTOR ADORESs PO Box 64 c,,s.A,z,L i n d e n , CA 95236 _ <br /> SUaCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRE3s CITY/STATEIZJP <br /> LICENSE X Cyr U"11 D D-G9 o Other NUMBER 377923 EmRAnoN DATE 7/31 /19 <br /> DOMESTIC WELL SAMPUMG_C General lAneraliCaliform Bacteria(4391)E DibromochlDropropane(4392) Arsenic(4393) <br /> INTENDED USE Cl OomesOdPrivate XbrigallonlAgriculturai C Industrial C Water Quality Mon itoring O Sal SamplinglCharaclerization <br /> U Publ.rWalerSyslem <br /> Ifd:TTemnl Rom Owner Wa'erSyslern Name Corday Nmu-Vr Pnone Number E <br /> TWE OF WORK 0 New Wei C Replacement Well D Well AlteratiuNModiO®tion C Other f'T <br /> D MDftiWl19Well(S) ADfwelts C SoilBcnng(s) :clb06r9s ❑Gea(ectmlcal sorbori <br /> C Out-CfSetvfceWall C Out-Of-Service Well Renewal 7 Cross-Connection Repair <br /> New Pum C Pump Replacement G Pump Re air Raise Well Casing <br /> WELL CONSMUCUON 1018 <br /> Drrlling Method O Mud Rotary G Air Rotary C Auger O Cable Tool -1 Push Paint n 011ier Uhl a <br /> Proposed Well Dapth ft Excavation in diameter �--Open Bottom =Gravel PacWGravel S[ze COONTM <br /> G Conductor Casing in diameter I Conductor Casing Depth ft H r NTA <br /> Well Casing Diameter_in ThldmesslGauge)ASTM Srhed = Steel O Plastic C Stainless Steel C Other TMENr <br /> Grout Seal Depth ft O Neat Cement(94 lb ba9t5-10V1 water) D Sand Cement sarin miw7 gal water <br /> ❑8 entonite(20%s odds) J Other <br /> IGroutPlacement Method G Pumped D Free Fail ]Oilier C Retardant I Acmalemtor(name) <br /> PEDESTAL Installed By O OdIler 2 PumpConliactcr 0 Other -- <br /> C Concrete Pedestal CDimensiors:Wdlh it Length ft Tack in ) Christy Bax O Stovepipe <br /> Purim C Submerstle Turbina C Other NP Pump Ser ft Standing Water Level ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK rmLL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQWN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS- I ALSO CERTIFY THAT RAY REQUIRED UCENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE 130ARD AND THAT i AM IN COMPLIANCE WITH ALL <br /> WORKE DMPENSATION <br /> MINI M 24NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953- 697 <br /> SIGNED ` � T,T orporate SecretarcyA, <br /> S) I I I <br /> f <br /> I 1 <br /> � � I <br /> DEP RTMENTUSE Y <br /> Application Accepted By Date�w� Area Employee ID#��/�Ij <br /> Grout Inspection BY Date '7 SPECIAL WeJI Permit <br /> Pump Inspection By r Dale ❑ WAIVER Received <br /> Soil Boring Inspection By Data Constructed Well Depth fi <br /> COMMENTS <br /> PESC Recelved Checm Amount Date PermrV Involce* Well 1D# <br /> Co Info - e5t— I Remitted Service Rigluest 14 <br /> Ef1J GC6 BN'In6 /f� n� O� Il ALL fPL'NP?ERt"71T <br /> E-d �L98L8860Z Y`�1 g�-� g35b,<S OUB SaaIIuQ acUeiAAnd d9£:EO8L LZ 5nV <br />