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WELUPUMP PERMIT ? / I <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> T <br /> JOB ADDRESS 16590 S. Murphy Rd. CITY/ZIP Escalon 95320 <br /> D <br /> CROSSSTREET S. of Louise Ave. APN 203-220-01 PARCEL sIzE 40 LAND USE APPLICATION# z <br /> OWNER NAME Hendley Farming, Inc. —PHONE 209-985-4955� ernon E � `" <br /> OWNER ADDRESS 16590 S. Murphy Rd. cITY/sTATEaIP Escalon, CA 95320 <br /> CONTRACTOR Hennings Bros. Drilling Co., Inc. PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd. CITY/STATE/ZIP Modesto, CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE XC-57 C-61 I D-09 I Other NUMBER 290813 EXPIRATIONDATE 5-31-18 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE i Domestic/Private rrigation/Agricuftural !I Industrial i Water Quality Monitoring r;Soil Sampling/Characterization <br /> i 1 Public Water System <br /> If different from Owner. Water SyStonl Name, contact Nam or Pnone Number <br /> TYPE OF WORK XNew Well I Replacement Well 1 Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells ❑Soil Boring(s) a of borings i i Geotechnical a of borings <br /> F.Out-Of-Service Well Out-Of-Service Well Renewal ❑Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method I_ Mud Rotary ❑Air Rotary I Auger 1 Cable Tool L!Push Point I1 Other Reverse Rotary <br /> Proposed Well Depth 400 ft�A //��Excavation 22 in diameter Open ttom XGravel Pack/Gravel Size_in diameter <br /> Conductor Casing-14—in <br /> in diameter / Conductor Casing Depth a ft <br /> Well Casing meter 12 in Thi–duress/Gauge/ASTM Sched SDR21 i Steel •OPlastic [ Stainless Steel I Other <br /> Grout Seal Depth 50 ft I Neat Cement(94/b bag/S10 gal water) 1(sand Cement 15. sack mixl7 gal water <br /> Bentonite(20%solids) Other 7� <br /> Grout Placement Method LXPumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By I i Driller XPump Contractor i Other <br /> I Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible'. Turbine - Other HP Pump Set it Standing Water Level ft <br /> 1 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 CALIFOTIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. t g <br /> MINIMUM XHOUR ADVA CEN EQUIRED FOR INSPECTIONS <br /> SIGNED Vol E Vice President DATE Apr.9, 2018 <br /> will 011 <br /> PAYMENT <br /> ECEIVED <br /> PP 10 2018 <br /> JOAQUIN COUNTY <br /> JOAQUIN <br /> TH DEPARTMENT <br /> DEPARTMENT USE/�ONLY / <br /> Application Accepted By Date " Area Employee ID# <br /> Grout Inspection By <br /> Date SPECIAL WBII Permit <br /> Pump Inspection ey Date WAIVER Received <br /> Soil Boring InspeFtion By Date Cons cted Well Depth ft <br /> COMMENTS IJU 6, 3 1 1 – Ci jlD <br /> S1� I2 M U� LII �� W211 frM,. J! l Lr1� <br /> P PE SC Received Check#/ Amount 'Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Re uest# <br /> q36`I 1g <br /> EHD 43-08 WELL/PUMP PERMIT <br /> 8/04/08 <br />