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WELL/PUMP PERMIT <br /> ` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZtELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joe ADDRESS 500 Bast Louis Avenue CiTYZP Lathrop/ 95330 m <br /> n <br /> CROSS STREET C ainhridgu Drivc APN 198-120-080-000 PARCEL SIZE 117 aC LAND USE APPLICATION# N/A o <br /> m <br /> OWNER NAME ASPIRMt Projwrltci,R&B Louisc,LL(.anti RMDcltu,1.1.C,00 ECS Corp PHONE Rogct-.Ashton 925-969-92.13 u <br /> OWNERADDREss 2228 I-ry1r j,,sLUn Street CITY/STATEMP Oakland,CA 946(16; <br /> CONTRACTOR - •Ceti PHONE <br /> CONTRACTOR ADDRESS f7 ,d CRY/STATEIZIP i1ioa._....t(+n t'A 1717^__, n(1 <br /> SUBCONTRACTOR I'.XPIOration GCOScnicc5,Inc. PHONE 408-280-6822 <br /> SUBCONTRACTOR ADDRESS 153_Industrial AVC111LIL' CITY/STATE/Z7P San joss,CA 911 12 <br /> LICENSE X C-57 _C-61D-09 Other NUMBER 'iti'L 27iii E%PIRATION DATE 12/31/19 <br /> ". <br /> DOMESTIC WELL SAMPLING:. General Mineral/Coliform Bactena(4391)❑Dibromochloropropane(43921\.Arsenic(4393) <br /> INTENDED USE Domestic/Private Inigation Agricultural Industrial C Water Quality Monitoring 'Sail Sampling/Characterization <br /> j Public Water System <br /> it dWerent from Owtet V;atn System Name centad Name cr P m—N—Z, <br /> TYPE OF WORK r-New Well n Replacement Wel- Wel Alteration/Modification :Other <br /> 0 Monitoring Well(s) #of+wits Vrod Bohng(s) a°b—ns 'x Geotechnical -•ti- a , <br /> Out-Of-Service Wel 0 Out-Of-SorAce Wel Ren—tal Cross-Connection Repair <br /> New Pump i Pump Re ,cement 0 Pump Repair Raise Well Casco <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary Auger '. Cable Tool Push Point 'i Other arca Fush <br /> Proposed Well Depl,lZ1Z-?eft Ezw•mlion in diameter Open Bottom i Grovel Pack/Gravel Size_In diameter <br /> ..Conductor Casing in diameter r Conductor Casing Depth R <br /> Well Casing Diameter in T hicknessiGauge/ASTM Sched Steel :Plastic 0 Stainless Steel D Other <br /> Grout Seal Deplh le Jd , N Neat Cement l94)b bag15-10 gal water) Sand Cement seek mix?pal water <br /> .Bentondo(20%solids) Other <br /> Grout Placement Method Pumped Free Fall X Other "'"" Retardant!Accelerator(name) <br /> PEDESTAL Installed By :i Driller " Pump Contractor Other <br /> 1 Concrete Pedestal Dimensions:V.Sdth ft Length R Thick in .Christy Box Stove Pipe <br /> PU61P ..Submersible['.Turbine Other HP_ Pump Set ft Standing Water Level It <br /> I HEREBY CERTIFY THAT VE PREPARED THIS APPLICATION AND THAT THE WORT( WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN CJU <br /> IT, <br /> OROI'APICESL.A.1, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQLiRED UCFNSE IS <br /> CURRENT AND WITH CA IFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM1t IN !t06Si-L{ANC= :'v';Tri A.-_ <br /> WORKERS COMP NSA��k.� <br /> nu\" ii\ J I IL C KCUUIKc_U P K aal tL l vulva L ASE CALL(209)9 3-7 97 <br /> SIGNED 1 TITLE 1 �� DATE4 Le <br /> • �� <br /> I OL <br /> f <br /> I i I ? Z01,9 <br /> I IUiN C <br /> I I O p'yFiyOU-14 <br /> N�, <br /> I I I 9RTM�NT <br /> I <br /> -- I <br /> II <br /> P AR ME NT U E NL /�JJ <br /> Application Accepted By ate Areae Er7;7byee ID3-�`��&` — <br /> Grout Inspection By Date SPECIAL WeII Permit <br /> Pump Inspection By_ Date WAIVER ReCelVed <br /> Sod Boring Inspection By v7- Datc � Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#1 AmountDile I PermrI Invoice# Wel)IDN <br /> Codes Info B Cash emitted I Service Renuest# <br /> EHD t1i5 rc..ue 41t4113 �� WELL/PUMP PERMIT <br />