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e C <br /> 18241 WELL/PUMP PERMIT ,��3 IZ- <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205. 232 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT GALL~ 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 14320 W. SCHULTE RD- CITY/ZIP TRACY 95377 v <br /> n <br /> CROSS STREET LAMMER S APN 2 0 9- .4-036 PARCEL SIZE52 8 8LAND USE APPLICATION# <br /> ni <br /> OWNER NAME RRT PARMS (�PCY\� �Q)Z PHONE408 391 8401 <br /> OWNER ADDRESS ARA W A V CITY/STATC'/ZIP PR EIVIONT CA 94539 <br /> CONTRACTOR . Delta Pump-$Tn(,KTnN ARMATURE & MOTOR WORKS 11"(1 . 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-57 KC-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/1Ln <br /> GE=OGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ❑ Domestic/Private Xa�rigation/Agricultural ❑ Industrial 0 Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK ❑ New Well 0 Replacement Well ❑ Well Alteration/Modification 0 Other <br /> 0 Monitoring Well(s) #of wells 0 Soil Boring(s) #of borings ❑ Geotechnical #of borings <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> Cl New Pump X)eump Replacement 0 Pump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑ Mud Rotary 0 Air Rotary 0 Auger ❑ Cable Tool ❑ Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel 0 Plastic ❑ Stainless Steel 0 Other <br /> Grout Seal Depth ft 0 Neat Cement(94 lb bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br /> 0 Bentonite(20%solids) ❑ Other <br /> Grout Placement Method 0 Pumped ❑ Free Fall ❑ Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP 0 Submersiblegjfurbine ❑ Other HP Pump Set ft Standing;Water Level ft <br /> I 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 /> UURRENT AND ACTIVE WITH THE CALIFORNIA GUNTRAC'I OK5 STATE LICENSE BOARD AND THAT.1 AIM IN COMPLIANCE Wi1'H ALL <br /> WORKERS COMPENSATION LAWS, <br /> MINJ�ILPJA 24 i-1OUR ADVAAC:E NOTICE REa.LJI1'EiD FOR INSPECTIONS <br /> SIGNED �'- — TITLE CE'0 DATE / 1 1201 ti <br /> r <br /> OWENS-ILLINIOS GLASS <br /> MFG.ENTRANCE TO THE <br /> PUMP ON EST SIDE OF <br /> DRIVEWAYI' <br /> PUMP/WEEL 15 LOCATED AT THE END OF <br /> THE ROAD.APPROX.059 MILES FROM <br /> THE ENTRANCE AT SCHULTE RD. <br /> N NT <br /> FO <br /> • <br /> k <br /> DEPARTMENT USE ONLY <br /> Application Accepte Date Area Employee ID#� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date U 3 WAIVER Received <br /> Soil Boring In ction By Date Constructed Well Depth ft <br /> COMMENTS ,na4 1-11,r P1 <br /> PE Sc Received ec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Remitted Service Request# <br /> 140.Dol o a�z�3� LA-H6 SQc90_7i�C;53g3l�b <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 8/04/08 <br />