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888 '°N WbLS 6 8106 'Zl 'n°N ani l pan a°a� <br />WELUPUMP PERMIT <br />SAtr JoAquirt Courm ENviRcums TTAL Herr DrePARmterr I US E :sTHnraToa Avamre- STocKToN CA 95203 - !209)466-3426 <br />PERNT <br />ADORERS <br />953-7697 FOR INSPECTIONS <br />Cory/21P <br />Name L N i 1 n, Ire T< <�e��> I x a 1 `v ", s <br />Aa.. L- 0 0 1 LA <br />�. <br />,cTOR Purviance Drillers <br />,croR Aawmss PO Box 64 <br />nTL& Tt <br />nRAcmx ADDRESS <br />- — c S7 0 C-61 -:1 D -a9 ❑ Other <br />Wart ra3utu <br />' V _C) I MCEL S () (LLAND USE APPurlmDntR <br />'a"v4— CfrYISTATEMP <br />Inc Paao>s 209-887-3554 <br />CrretSTATE ,PLinden, CA 95236 <br />PNWXE <br />CriY1STATSO <br />NUNMER 3 7 % 9 2 3 Eum-now DATE 7/31/19 <br />Dowsmn WELL SAmpLING:=General MnerallCo6{orm Bacteda (4391) C Dbmrnochloropropane (4392) = Arsenic (4393) <br />mxoEo Use 0 DomeslirJPrirale G InigationlAgricultual C Industrial Ei Water Quabty monitoring O Soli Sam plingtCharacterizabon <br />C Puhfcc Water System <br />rr6Prm ImmOrmer Wafer 3ysiern Mme Comm waC or Peoae Nwnrw <br />TYPEQP WORK 0 Nevr We9l C Replacement Well O Weg Alteralion/Modification C 011ier <br />C Monitoring Wt41(s) gof ""ells G Sofl eorng(s) RpJOarngs C Geotechnical 901'"s <br />C. Out -0E -Service Well C out -Or -Service well Reneural 7 Cross-Conneclion Repair <br />VIM <br />D6111ag Ma hod C Mud Rotary r Air Rotary 7 Auger 7 Cable Tool -i Push Paint n Other <br />Proposed Well Depth ft Easavation in dframefer a Open Bottom C Gravel PadVGra"eI Size in diameter <br />D Calductor Casotg 1n diameter f Conductor Casing Depth 8 <br />Well Casing Diameter_ in ThidmeWGauWASTM Schell --Steel O Plastic ❑ StainlessSleel -D Other <br />Grant Seat Oeplh ft -3 Neal Cement (94 lb baya70gal vratai) .3 Sand Cement sack mbd7 gaIvrAer <br />0 Bentonile(20%zolids) 7 Other <br />3rout Placement Method D Pumped D Free Fan 7 Other Z; Retardarrt/Acceleralor(rmtre) <br />Pura+ Installed By 0 Driller 7 Pranp Conlrectm D Other <br />C ConcretePedestolCOtmenstoms-Width R Length ft Thick in -1 Chrimsox []Stovepipe <br />Puhip f Submersiblep Tutbine O Other. - tiP PrrmpSF fl Standing Walrst�rel ft <br />t 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 CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />IYIIN! ?4rI R (D NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-76�9933 <br />�;,,orporate Secretary <br />rn <br />m <br />D <br />0 <br />Cn <br />R� Y�ZA <br />CEOV�O <br />Npv 16 201 <br />,4Q4j8 <br />//?p cou <br />?'/YpEPgR Qjv T Y <br />D� ARTMata US Y n/l LV <br />Application Accepted 8y Oale �l L'� Area f I Employee 109 VV 0'Vf'1 <br />Grout Inspection By Dale PECIAL Well Permit <br />Pump Inspecrmn By b'p w"),r t Date ri WAIVER Received <br />Sod Boring Irtspection By Data Constructed Well Depth ft <br />rnm "MiTc <br />EH043-ta enr115 <br />Ilni g'47�7 723 <br />Itruer r"ea"r <br />Z'd VZ9U9260Z 01.11 SaaIIiJa 001_1e1nand 1397:0l 96 Z6 AON <br />