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►� 3 l2 7'1 <br /> cu, � 3..od rnihal Scan ''1J51�� � <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENMRONMEIfTAL HEALTH DEPARTMENT 1868 EAST HAIELTONAVENUE-STOCKTON CA 95205-(2091468.3420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> Jos AODREee Api2ligation 1 of 2- 1181 Zuckerman Rd Cm/Zlp Stockton. CA 95206 DD <br /> canes STREET Access Road / O <br /> APN 129- -,912 pARceL3RE AxO USE AvvtICAnONi <br /> OMERNAMEPac ig Gas f5 El i • M,,.,,T(T t Maeda PHONE (925) 328-5637 <br /> Owass AOmiea6 121 Bollinger Canyon Rd 0wI/ m/STATEJZs, San Ramon, CA 9454 <br /> CONrrucroR American Construction and Supply Inc PHONE (415) 927-2024 <br /> COWRACTORAmeeEe3 45 ScIn ClementeDrive. Suite A-10 C"fSTATE" Corte Madera CA 94925 <br /> SUBCDHm t"OR —N/A PHONE <br /> SUeCO AGTORAgaiEeB CMISTATEZP <br /> UCEME XC-57 CC61 nD-L9 =Other NUMBER 310599 EKPIeAnONDATE 03/31/2019 <br /> GEoo"PNICALINFORMATON: COondinaleiX 37.988229 Y -121.479492 Townahip92N Range 04E Sxgon__Zl <br /> NRNDEO USE .-Dameetididvale Im92110NAgNUlturol _ In4usnal ^Water Dually Monihamg D Soil Sampaing/Claracerizaso, <br /> _Pubic Wafer System <br /> lfdfl wre Owmr a am a pr ry <br /> TWEOFWORK XNew Well = Replacement Wall C Well AHera6oNMod ceso XOUtar Cathodic Protection <br /> Monitoring Wel(s) Bof wells $Shc Bonns(s) 00bOdrw Geotechnical eon bonro. <br /> _Oul-Of-Service Wel Oul-Of-Service Well Renewal D Crose-Cormecllon Repair <br /> New Pum -NaReplacement Repair n Rahe Well Casino <br /> WELL COARIMUCTION <br /> Drilling Method - Mod Rotary -Air Rotary X Auger 71 Cable Tool -Push Point "' Ona <br /> Proposed Well Depth 15 ft Escavason 1—In diameter _Open Bottom '.-.Gravel PeWCxauel Size in diameter <br /> . Conductor Casing N/A In diameter / Conductor Casing Depth n <br /> Well Casing Diameter-NIA in Thicimess/GBUge./ASTM Silted N/A ]Steel D Please -.Stainless Steel 0 Other None <br /> Grout Seal Depth 2 ft X Neat Cement(941b bag(5-l0galwaw) .!Send Cement sack Mora pat water <br /> C Bentonite(20%solids) ❑Other <br /> Grout Placement Metlwd O Pumped X Free Fall COther _Retardant/Pccelerator(name) <br /> f lawAL Installed By X Driller 1,Pump Conlramor 011ier <br /> Conenla PSCBatal-Oimenabra:Width 8 Length it Thidr in X Christy Box -Stove Pipe <br /> PUMP -Submeml Turbine Omer HP_ Pump Set A Standing Water Level 8 <br /> I HEREBY CERTIFY THAT I NAVE PARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> - JOAQUIN COUNTY ORDINANC STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE I6 <br /> CURRENT AND ACTIVE WIT"E CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATON LAW <br /> MINIMUM 24 F� ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)957-7697 <br /> SMNEO__ Steve McKim TITta Vice President DATE 04/04/2017 <br /> CE1���® <br /> 052017 <br /> UMfNTq Nl <br /> PARTMFNT <br /> EP RTMENT UISE ONLY �x/ <br /> Application Accepted By r Date Mea - Employee IDA <br /> Grout Inspeaio - Date = SPECIAL Well PemIR <br /> Pump Inspection By Dale _ WAIVER Received <br /> Soil Banns Ins n B Oto Conatructatl WeII Depth ft <br /> COMMENTS /-�' �i .[(j /L'1G �ii A%G'AT r�/�{>•r <br /> JE SC Received chattel Amount Poe Portnitl Invoice+! Well 100 <br /> Into B Caeh Remitlad S6LmIC uest0$ I AFq h SROo 1'1151 <br /> re 1 1 <br /> V.043-00 <br /> M2 � wDt muse vEaAvr <br /> 16y�' - <br />