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09/14/2018 07;52 Canepa & Sons (FAX) P.002/010 j WELLIPUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 9868 EAST HAZELTON AVENUE•STOCKTON CA 9520$ -(209)460-3420 NON-REFUNDABLE PERMIT CAL 0 963.7697 FOR INSPECTIONS 1EXPIRES )YEAR F OM DATE ISSUED SQ Joe ADDRESS CITY/LIP r� CROSS `1^ APN F✓D ��IO� PARCEL 812E AND PPLI.CAATION# o OWNER NAME r-7 c,..�/I •�S L.J� I MON�7n ✓ ~0 , OWNER ADDRESS &577 c�� kf`i1�P rx r CONTRACTOR CANEPA AND SONS,TNC. Vrvl/�(Xll/C�, lil/� PRONE (209)532.1136 CONTRACTOR ADDRESS 14384 CUESTA COURT CITY/STATE/71P SONORA,CA 95370 SUBCONYRACTOR PHONE 6U2CONYRACYOR AODRH6e CITY/STATE/ZJP IJOENSE INN-67 D C•61 D D•02 0 Other NUMBER 425749 EXPIRATION DATE 7/3)/2020 Domwic WELL.SAMPLING:D General Mineral/Coliform Bacteria(4391)Q Dibromochloropropane(4392)D Arsenio(4393) INTENDED 118E D DomesllwPrlvate y(rrigatlon/Agricultural ❑Industrial D Water Quality Monitoring D Soil$ampling/Cheractedzalion O Public Water System If different from Owner; Wator ayaWm Noma Contoot Name or Phcno Nuntbar TYPE OF WORK )(New Well ❑Replacement Well ❑Well Alteration/Modification D Other D Monitoring Wefl(s) sof wells ❑Soil Boring(a) 9Qfa041)e2 ❑Geotechnical sof borinec D Out-Of•Scrvicc Wcll ❑Ou40f-Service Well Renewal D Cross•Connectlon Repair ❑New Pump C Pump Replacement ❑ Pump Repair D Raisc Well C;isiniy WELL CONSTRUCTION Drilling Method)(Mud Rot'a7_D Air Rotary ❑Auger ❑ Cable Tool D Push Point 0 Other Proposed Well Depth `3 h EXcavetlon. 20�in diameter ❑Open Bottom (Gravel Pack/Gravel Slse 31 In diameter ❑Conductor Casing in diameter /mContactor Cn ^esing Depth / Well Casing Oleeter� , In -hlckness/Gauge/ASTM Schad�GX Steel D Plastic G StainlasS Steel C Other Grout Seal Depth. r;�Lb fl ❑Ncat Cement(941b b4;B16.10 gal-etcq )CSand Cement /Or� sau m/xn gel water o 9entonile(20%solidE) D Other A� Grout Placement Mathotl Pum ed 11 Free Fall 13 Other D Retardant/Acccicrator(name) Pi ,ke PE Installed By 11 Driller APump Contractor 11 Other �I/� T ❑Concrete POd=tal DDimansions:Wldth It Length R Thick In ❑Christy Box D Stove Pipe v � PUMP ❑Submersible Turbine ❑Other HP Pump Set It Standing Water Level tt [n I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONS IN ACCORDANCE WITH SAN 1 �oe� JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, t ALSO CERTIFY THAT MY REQUIRED LICEN CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH 0AQU/ WORKERS C ENSATION S. H N IRON NCOUN M I 4 H U ADVANCE NOTICE REQUIRED F l F CTI ®NQS-;1LF5A8E CALL(209)9fy�q- 6{97 pFPgQFNyT�,qL �' SIGNEDfto TITLE�kJ -` i VID1 ° ECEI'� ED �r SEP 1� 2U�� IR ONMENTAL HEALTH PERMIT/SERVICES D AR ENT U E O rILY ] �/T/� Appllcatlon Accep led By D e Area _( 3 Employee ID4 IG1 Grout Inspection By- V Dste O ❑ PECIAL Wall Permit Pump Inspecd!on By Date ❑ WAIVER R®Calved Soil Bering Inspection By Date Constructed Well Depth ft COMMENTS PE SC Reeelved Cheekll/ Amount Date Permit/ Invoice ft Well IDN Code [nip B Cash Remitwd rvicc e u td Time—Se ,,T —Sed, 14. -2018— 1:52AN}—No, 4137 WELLrPUMPPERMrr �--I' cnme reuse ,,