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`20601 WELL/PUMP PERMIT u <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />INUIN-MIzi-LINUAbLE rLKMII <br />UALL (1UV) yS:S-fbV1 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />T <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE . 0 C-57 N C-61 ❑ D-09 ❑ Other <br />TYPE OF WORK 0 New Well 0 Replacement Well ❑ Well Alteration/Modification 0 Other <br />0 Monitoring Well(s) # of wells ❑ Soil Boring(s) #of borings 0 Geotechnical #of borings <br />0 Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />❑ New Pum O)Wp Replacement ❑ Pump Repair ❑ Raise Well Casing <br />WELL CONSTRUCTION <br />heck <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool ❑ Push Point <br />❑ Other <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br />❑ Conductor Casing in diameter / Conductor Casing Depth <br />ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched ❑ Steel <br />0 Plastic 0 Stainless Steel ❑ Other <br />Grout Seal Depth ft ❑ Neat Cement (94 Ib bag/5-10 gal water) <br />❑ Sand Cement sack mixt7 gal water <br />❑ Bentonite (20% solids) ❑ Other <br />Grout Placement Method ❑ Pumped 0 Free Fall 0 Other rl Rptarclant <br />/ Arr.PJPratnr fnnmPl <br />PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br />ll ❑ Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br />PUMP kkubmersibleo Turbine 0 Other HP Pump Set ft Standing Water Level ft <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 WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATi4N+*W8 --� <br />MINIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED /��f�^� TITLE CEO DATE 8/22/18 <br />PUMP/WELL is located <br />approx. 1,325.72 ft. from ED <br />DevnesRd. - - <br />U� '1 4 18 <br />ui11^I/ rt � i <br />ENVIRONMENT <br />u v <br />PFR <br />MITISER TM <br />PA TMENT <br />&�K <br />LY <br />Application Accepted By Date� <br />Grout Inspection By Date <br />Pump Inspection By bate ? f <br />Soil Boring Inspection By If Date <br />COMMENTS <br />Area—,�/-�?q Employee ID#� <br />PECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth <br />ft <br />PE SC <br />Codes I Info <br />Received <br />Ay <br />heck <br />Amount <br />Vernitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Well ID# <br />313 <br />82718 <br />� --f%' '7C7 <br />Enu 43.06 <br />8/04/08 WELL /PUMP PERMIT <br />