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SZWIN AdN :: G[06 -l6 'Pny auiil paAl ;);d <br /> WELUPUMP PERMIT <br /> SAN JOAotnN COUNTY ENMONUENTAL HEALTH DEPARTmEwT 180 EAST HAMTON AVE WE-STOCKTON CA 95205-(209)469-3420 <br /> NON-REFUNDABLE PER1111T CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADOitESS T RT Hwy 88 DITTmPL o d i A 5 2 4 0 r" <br /> CROSS STREET O AP O5Y ZV0 7 P-c-SIZE/_C-LL.AND USE APPUCATTON 4 I a <br /> m <br /> OWNER NWE George Alves PHONF2()_9-6t09_n6?5 <br /> OWNER ADORES* P .0 . Box 688 ctTwsTAT jZP L o c k f o r d CA 95237 <br /> I <br /> CONTRACTOR Purviance Drillers , Inc PHONE 2.09-887-3554 I <br /> CONTRACTOR ADORNS PO Box 64 QtV/STATFJZIPL i n d e n , CA 95236 <br /> SUBCONTRArMR PHONE <br /> SUBCOVTRACMR ADDRESS CITYISTATEMP <br /> LICENSE C-57 u css :10-09 0 other NUIUBER 377923 E"uun*ri DATE 7/31/19 <br /> DowSTIC WELL SAMPU.w:,::General Mneraucoiform Bacteria(4391)=Dibromochbropropane(4392) Arsenic(4393) <br /> INTENDED USE 0 DomeSSrArivale Irrigation/Agticulturai C industral C Water QualityMonitorM9 01 Soil Sampling/Characlenzation <br /> O Public Water System <br /> 1!d'fteentrmm Omer. WalerSyslem Name Contact Naas crPnone Nurnbrr <br /> TYPE OP WORK D New WeJ C Replacement Well 0 Well AllerdliorUModifiradon 0 Other <br /> 0 Monitoring VYell(s) Aofvyells G Soil Bonng(s) r-GeoteCnnlCal aor bor ngs <br /> 0 Out-Of-Service Well c Out-0f-Service WPI Renewal 0 Cross-Connection Repair <br /> ew PLffnp C Pump RepLacement C Purnp Repair 0 Raise Well Casing <br /> WELLCONS7RUCr10N <br /> Ddlltng Method D Mud Rotary r Air Rotary D Auger 0 Cable Tool ...7 Push Point n Other •'W!I/; <br /> Proposed Well Depth It Excavation in diameter 0 Open Bottom C Gravel PacklGravel Size_+y jn diameter 20� <br /> D ConduclorCasing in diameter I Conductor Casing Depth n F ✓o 8 <br /> Well Casing Diameter_in Thickness/GaugelASTM Sched _Steel 0 Plastic C Stainless Sleel C Other co <br /> Grout Seal Depth P, 0 Neat Cement(94 Th bag/3.70garwe" D Sand CementNJ sack VrWe FNTa, <br /> D Bentonite(20%Solids) other "C Tui- <br /> GroutPlacementMethod 0 Pumped D Free Fall n Other 0 Retardant]Accelerator(name) r <br /> PEDI37AL Installed By D Duller 0 Pump Contractor 0 Other <br /> 0 Concrete PedestalLDtmensions:Width ft Length ftThtck in C ChristyBox O StwePlpe <br /> PUµp Submersible0 Turbine 0 011ier HP Pump Se; n Standing Water Level / ft <br /> 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORE(WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAVIS, 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 /> WORKE N'PENSATIONLAINS. <br /> MINI M 24 O DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIG ISE �iGlibNL' TT�orporate Secretarl3'ATE <br /> I Ir <br /> I i <br /> I <br /> I <br /> 1 <br /> I <br /> I <br /> � I <br /> I � I <br /> I <br /> I <br /> I i I <br /> i <br /> L.1 <br /> ENT E O L <br /> Application Accepted By &PS:A;�LT'Oale Z - Area Employee IDR <br /> Grain Inspection By Cate D SPECIAL Well Permit <br /> Pump Inspection By Cate D WAIVER Received <br /> Soil Boring Inspection By Cate Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#! Amount bate Permit' Invoice# Well IDG <br /> Codes. Info ash Remitted ryie st# <br /> I <br /> EFi353f16 PAIII6 ��� .�IJ/���r�/�C/ W=L.L rM'Y.P PeRe.Slr <br /> Z'd �L�£L8860Z a`/e out SaalluQ aOuelAind d9£:£0 9L �Z 6nV <br />