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s <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1069 EAST 1HA7EL7oN AVENUE-STOCKTON CA 95205-(2091469-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> — N <br /> Joe ADDRESS 390 Towne Centre Drive CITYfZ,P LothroW 95330 re <br /> CROSS STREET MCKee Blvd APN 191-700-WO PARCEL SIZE 30DO ac LAND USE APPLICATION M Government <br /> OWNER NAME City Of Lathrop - - _- _ PNONE 209-941-7200 <br /> OWNER ADDRESS 390 Tame Centre Drive _ _ CfrY/STA <br /> CONTRACTOR -- - ng Cnh 1...... r.... -.--_ - PHONE V � <br /> CONTRACTOR ADDRE68 _ CITYISTA _- --_.._. <br /> SUBCONTRACTOR Cal forma Geokch------- --- --- PHONE 831434-1064 <br /> SUBCONTRACTOR ADDRESS 68B61Nle9e Parkway --_-- _.-, CITTISTATEJZiP Dublin.CA 94508--------__.---- <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 912382 EXPIRATION DATE 9/30/2020 <br /> DOMESTIC WELL&4MPLING: General Mirleral/Coliforrn Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INnINDED USE 1T Domestic/Pnvate InigationiAgricusural Industrial Water Quality Monitoring X Soil Sanp1mg/Charadenzation <br /> 0 Public Water System <br /> 9 deererit hom 0—, Water System Name Conlap Name a Phone Number <br /> TYPE OF WORK ^New Well Replacement Well Watt alerabon lModihcahon Other <br /> Monitoring Well(s)__ _Mof wells Soil Boring(s) sot boraips X Geotechnical 3._-a dWimps <br /> Oul-Of-Service Well Out-Of-ServioeWell Renewal Crass-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing -__ --- <br /> WELL <br /> _WELL CONSTRUCTION <br /> Drilling Method Mud Rotary II AY Rotary X Auger Cable Tod Push Point Other <br /> Propoaed Well Depth i I1 Excavation in diameter Open Bottom Gravel Pack/Gravel Sae in diameter <br /> Conductor Casing__ In diameter / Conductor Casing Depth _ _ _ it <br /> Well Casing Diameter id tThickuge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth A Neal Cement f91 19-Dag/5-10 got waren Sand Cement _ _-sack rrdxl7 pal water <br /> BemoMs(20%solids) r <br /> lacement M <br /> Growl Pethod Pumped X Free Fan Other Retardant/Accelerator(name) <br /> PEDEETK Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width R Length K TMCk in Christy Box -Stow Pipa <br /> rPUMP Submentible Turbine Other---- _HP Pump Set tt Standing Water Level II <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN CADE <br /> DI CES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS CN WB.,AIiNCE NOTICE REQUIRED F INSPECT DNS-PLEASE CALL(209)953-7697 G <br /> SIGNED TITLE G �� DATE ` <br /> OR <br /> Z-1 81%ENV,Q4jlN c 19 <br /> CTy F qR� N�' <br /> i LL <br /> ( AR MENT U NLY <br /> se <br /> Application Accepted By `/ -vatehep _ E ployee IDS <br /> Grout Inspection By Date PECIAL WB11 erfTtit <br /> Pump Inspection By Date WAIVER Received <br /> Sal Boning Inspection By ` Dab Constructed Well Depth <br /> COMMENTS - - - - <br /> .. Nl/oPs Amould Dab 13ervlee R MtvoipR Well IDM <br /> o <br /> EHD was--it VWIII WEU(PUMP PERMIT <br />