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FIELD DOCUMENTS FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2103
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3500 - Local Oversight Program
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PR0544591
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FIELD DOCUMENTS FILE 1
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Last modified
6/21/2019 2:26:57 PM
Creation date
6/21/2019 11:30:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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APPLICATION FOR WELL[PUMP PERMIT <br /> 4 " JOAQUIN COUNTT PUBLIC HEALTH SERVICE► <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. B )X,%M 304 EAST WEBER AVENUE, STOCKTON, CA 95201588 <br /> (2091 4S"420 <br /> P%AUVRVIRLI UlbirTPIR 1 YjAk ROM VATI IMED <br /> APPJCATAK It HERE n MAGE 7O TNI[LM!.q AOU COUNTY FOR A PEr ff TD CONStTLJCT AJDgR 1ISTAL THE V+OM OESCFIS[O.TRt A KXATq A MADE N COMRJANCE VJRN SAN <br /> JOAG(RH COUNTY OCVROAHEHT TTTLE,CHART 9- J l 6.7 AMD THC STANDNpt OF LAK JOAOUM CDVHTTIlN HEALTH VUrvICTt,EWOPOHMENTAL HEALTH WMSIOH. <br /> JOE ADOALgoR A//F�Jw 10 IjA[7 �1U� cm�'lC]r^_IC.�"[�Y1 FARCEL LcvAFw <br /> oWHExt NAME 4.J/Yi-i'L �!D " r, AOOREIIROHE1 SID •d42 •8695 <br /> cDKrRACTGR��/l r - ADDIEnlifs r ucv PHONE 1510.31I.8901D <br /> HA CGHTRAcroR ADOPEw wYl n D IL �'SwCS�•48234o RgHE lS/o•68SI,(,I� <br /> rrqy wnl'RyMP ❑ ITV WELL ❑ EMEWT WELL ❑ WWOF No W[IL 1 ❑ OTHER <br /> ❑ MRALLATgN ❑ f sTlw WAA ❑CRDSKOwNtn FEPARI ❑ VAPOR EXTRACTgH WEL1 S <br /> D NA..❑RSI NY. DEPTH NMF LET_PT. FRIT WATER INET p <br /> fTTR D!NYFE ECE <br /> ❑ -oF-KRVICE WELL ❑ OEOWYSICAL WELL/ q WIL"Alq <br /> ❑DEE .cTgH: G)F4 ih'OKJ�. &K'I <br /> INia>ED us TYtt OF 1 h i11 R FCA O <br /> ❑ 1DUTLAL 13 OPEN LOTTOM GIA.OF V.'RL EXCAVATION L11, bA Of CONDUCTOR CASINO_ I�(A p <br /> ❑ DCHRSTCRRVATE ❑GRAVEL P*MMZE TYPE Of CA1PlOJRRU►UC DU OF v4u CASFNO Y�LQ p <br /> QKLJCM Fr IPAL ❑DREVEH OMKOfG+ovTKILL <br /> SPECOICATMN R <br /> ❑ ENRGATONIAA ❑OTHER GROUT VEAL P ALLED SY GROUT&RAND HAM[ E <br /> ❑ SIDNrtDRNG OPOUT KK RMFED� ❑Y. ❑PIA CONCRETT PE r7AL lrY DRRLER:❑Y. ❑W S <br /> APPROX.DOTH 25 LODXRIG CHEtTVE LOXATOA PIPE 1 <br /> R M&ID CORSTIRCTI0RT1rPiLNO MiTIOD: MUD RDTAW AIR ROTARY AUGER C&OU OTIRR� � <br /> I HE CEKTRY THAT 1 NAVE PREPAFEp TMS ARLICI AND D THAT THE WORK WILL SE DONE N ACCORDANCE VVRt(tW JOAOJ'M COLRTY ORDINANCES.FT ATE LAWS.AND RVLEL AND <br /> REo TgMS Of THE LAN JOMO COVHTY. NOM[OWNER OR Ucmam AOEHT•1 SIGNATURE CERTVRt M FOLLOWSq:7 CERTIFY THAT 11 THE PERFOPFA I j OF THE WORK FOR t CH <br /> T,ot PEFMR A ISSUED.1 WALL HOT ELIROY PERSONS SULJECT TO WOAJAAR'L CO%4 g ATION L.AWt OF CAUFOMEJk-• COHrRACTDR•L HRVNo OR SVILOKTRACTM SIGNATURE cvmmS <br /> THE FOM1 CERTIFY THAT IK THE MAWHRCN <br /> R .NCE Of THE VW FOR THIS RTOAR N MKOED,E 04ALL EAEPLOY PERSONS SUBJECT TO WCA W&COMPVk&ATpR LAVA OF <br /> CAIWItt �fyl/AL1 AFRlCAIET MVLT 1 OW''11bE AOVMK[POR ALL RtOW=INUIC W ApT/-(J`7011(M/[ L'L. COMPETE DMYAHO AT LOWER AREA FIONp[D. QE <br /> TRM �1IG{I, I �QNa rE1�, G• �t• 'I� <br /> PLOT RAH 0,. MAMI SPIN •I <br /> L. NAMES OF STIIELTS OR ROADS NEARER TO OR So JNDINO THE PPORRTY. A. IOC ATOM OF HOUSE SEWAGE bSPOSAI SYSTEM OR PRON,em <br /> 2. OUTLINE OF THE PROPERTY,OF~DIMEHSfOHt AJID NORTH DFRECTON. EXPANSION OF SEWAGE pSI+OSAL OY S. <br /> ]. D,MEN WjNED DUTLINTS AHD IOCATgN OF ALL UC 1T1AT AND P POSED L. LOCATOR Of VMLLS VIRHIN RADIUS of OW M,,N. ED FIfTV FT. <br /> CRVCTVR[S,SVCLVpNO CO 1 AREJ.S 1UCH A.�PATIOS,Dl0 VEWAYS.AND WALRL. ON THE FROPERTY OR ADJOMH O PROPERTY. <br /> .i. .r.. i <br /> .?.. ..q. ... _...i...........<.... ... <br /> R <br /> i' <br /> ....�. •.. p '... ... .r.... b 'll � . <br /> .;...._.j...._y_..i...........a......1........_. ........... ............ ......._...E ... _ _..e......?. .f'`4—H!--.-:� ...... .b•A.r.11 a/_.: <br /> i. .T.._..�......... <br /> i... '_...'... . ._..5.....:.........__2 _ .. .. <br /> ...e.....r. <br /> Dv ARTMOYT W E ONLY <br /> O M I'FMFI4R 1T DM FS E+�07 D.R <br /> D�•uR•A..P..I1�SY ' <br /> i <br /> ACC TERo ORLT: AO1 FACT <br /> R CDD4 PtE IrG ARAo{PlT RPfr'fm CHEC XI�CYN YCEIVm 1Y DAn R7MTA RVICS RtOV[LT R{Mw 1N'OK! <br /> �B 514I - 10-7 <br /> I <br /> 2 •d IC :01 96/10/20 W063 <br />
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