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Caa�:la.LalaaP, eIVMA •. C*033 <br /> WELUPUMP PERMIT <br /> SANJOAWIN CCUey,ENVIRONMENTAL HEALTH DEPARTMENT 1568 EAST HMLTON AVBNDE-STOCKTON CA 95205.(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joe Adman 3150 W Stewart Rd (South of Paradise Road) CnY72m Lathrop, CA, 95330 9 <br /> eI"Adise Road I Cohen Road APN 21321002 to 007 1100 <br /> Circus STREET PAIICFL Sam acres LAND USE APPLCAnom9 <br /> x;21021022; 21021002 <br /> OWNER NAME n ell'Osso 2133009 to 010 + 013 to 014 Nam;209-879-7900 <br /> GWNee"Dial 73 W. Stewart Roa$e!2!ffej0-- CM/StATeRP Lathrop CA, 9533b <br /> CONnUCTOR Celifomia Push Technologies, Inc./Gregg Drilling c Testing Inc. Peoria 510-357-3617/925-313-5800 <br /> LORIRACTIRADDREe 920 Aladdin Avenue / 950 Hone Road CTYSTATPRP San Leandro, CA, 94577/Nartinez, CA 2 1553 <br /> SUBCONTRACTOR <br /> PNpP <br /> SUBCONTRACTOR AOeREsa CDYIBTATIVIP <br /> LICENSE X C57 ,."I _D.09 _Other NUIIIMt 884827 EKPSIAININ DATE <br /> GEDCRAPHCAL IWMWTON: Coordinate% 37.800111' y-121.351911° Township— _ <br /> Range— Seetbn <br /> UBENoeo UaE ' DomestklRivate Inigadm/Agricultural Ind natal 7 Water OuMBy Monitoring X Soil SamplingrCharecronzadm <br /> Pu0lk Weter System <br /> ncn..nro oe,.r .m .me mew r. Me <br /> TmEOF WORK -New Well Replacement Well 7 Well AlteratumniModdication n Oder CPTS <br /> Monitoring Walla) IDiwelb lSoll Borvig(a) Aabdrg. %Gaotechrvicel 5d awtwvrMe <br /> _Out-OfSarmce Well J Out-0fSeMce WellRenewal is Cm9a-Cmnectim Rapeir <br /> -NeupumPump Replacement F Pump Reutr n Rabe Well Casing <br /> WELL LOHaTRucTNIM <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tod YPush Point Other <br /> Proposed Wan Depn130 t0 100H Fxcsvabon tin in diameter -Open BORarn J Gill PBck/Graval Size n dbmeler <br /> Conductor Casing in diameter / Conductor Casing Depth fl <br /> Well Cuing Glamour In Thickness GeugWASTM Schad -Steel n pluck f'.Stainlos Steel �Oder <br /> Grout Seal Dub30 to 1001 %Neal Cement(0416089310 gel water) Send Cenenl sackniz/7galwater <br /> _a <br /> Bentmlro f20%aalwa) Other <br /> Grout Placement Method 2 Pumped LFree Fall Coder :Retardant/Accelerator(name) <br /> peull InabIIW By Diller a Pump Contractor Other <br /> Csncnb Padaabl Dinanabm:Widh_ft LsnRM RThkk_in Christy But 'Stove Pipe <br /> Puw - Submersible-Turbine a Omer HP P--PS-t--ft Standing Water Level % <br /> I HEREBY CERTIFY THAT 1 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 /> MINIMUM 24UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TIILEStaff Engineer DATE 3-14-17 <br /> PAYMENT <br /> RECEIVED <br /> MAR 11 2011 <br /> JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> TH DEPARTMENT <br /> EPA TMENT 043EIONLY <br /> Application Accepted B Dsla ( I AreaE plOyee IDs <br /> Growl hgpecton By Date 4— rmil k1 <br /> Pump inspection By Data _ WAIVER Received <br /> S61 Boring Inspection By Dab Cembucted Wall Depth N <br /> COMMENTS <br /> PE SCe Received heeld/ Amount Data ParrlrW Imedul won IDI <br /> CodIn/o a Cash Remitted Service used <br /> iSt .aP 3g1 1.1 �lO Z <br /> EHD43W <br /> 19r12 NELL PULP PERMIT <br />