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SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPT WELL/PUMP PERMIT1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 458-3420 <br />n LUN-KEFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 16590 S. Murphy Rd. CITY(ZIP Escalon 95320 <br />CROSSSTREET S. Of LOL)ISP AVP APN 203-220-01 PARCELSIZE 40 LAND USE APPLICATION # <br />OWNER NAME -hendley Farming Inc PHONE 209-985-4955 <br />OWNER ADDRESS 16590 S Murphy Rd CITY/STATE/ZIP ESCalon CA 95320 <br />CONTRACTOR Hennings Bros. Drilling Co Inc PHONE 209-545-1185 <br />CONTRACTORADDRESS 1930 Ladd Rd CITY/STATE/ZIP Modesto, CA 95356 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br />LICENSE XC -57 7 C-61 0 D-09 E Other NUMBER 290813 5-31-18 <br />EXPIRATON DATE <br />k.00ramates x Y Tnu,..c6;., <br />NTENDED USE C Domestic/Private XIrrigation/Agricultural ❑ Industrial A Water Quality Monitoring D Soil Sampling/Characterization <br />u Public Water System <br />Indifferent from Owner: Water ys em ame Gon me or one um r <br />-. _.- --..-r.--� .�.,. .•�. _ ..cu rvrciduunnvwumcation a Umer <br />D Monitoring Well(s) # of wells El Soil Borin s # of bonngs L Geotechnical # of borings <br />9O <br />0 Out -Of -Service Well C Out -Of -Service Well Renewal D Cross -Connection Repair <br />New Pump I I Pump Replacement i I Pump Repair i Raise Well Casinn <br />Drilling Method E Mud Rotary a Air Rotary _1 Auger ❑ Cable Tool C Push Point Gid Other Reverse Rotary <br />Proposed Well Depth 400 ft Excavation 22 in diameter L Open Bottom X Gravel Pack/Gravel Size #6 in diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter 12 in Thickness/Gauge/ASTM Sched SDR21 D Steel XPlastic L Stainless Steel E Other <br />Grout Seal Depth 50 ft L Neat Cement (94 Ib bag/5-10 gal wafer) i Sand Cement sack mixf7 gal water <br />XBentonite (20% solids) D Other <br />Grout Placement Method XPumped 7 Free Fall E Other 0 Retardant / Accelerator (name) <br />PEDESTAL Installed By i Driller rump Contractor I i Other <br />I I Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box i Stove Pipe <br />PUMP E Submersible❑ Turbine E Other HP Pump Set ft Standing Water Level ft <br />------- <br />I <br />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 COMPENSATION^ LAWS. - - <br />T <br />D <br />A <br />m <br />N <br />�ZDEPARTMENT USE ONLY <br />Application Accepted By Date �`7 J area Employee ID# A n mj?(1 <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC Received <br />Info B <br />Chec <br />ash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Re uest# Invoice # WellID# <br />vi roo i8 i v <br />8/04106 WELL /PUMP PERMIT <br />