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F <br /> t <br /> WELL 1 PUMP PERMIT <br /> i SAN]DAQUIN CWNTv ENvI[IONMENTAL ..7fi DEPARTMENT 304 E WEBER AVE 3._ SrDcKTON CA 93202 -(W%468-3426 <br /> NON-REFuNDARLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE IssuED <br /> ]DBADDREM 6912 DELTA AVE. Crr <br /> „n,P TRACY,CA 95304 <br /> LleossstRELT TOM PAINE AVE. APN 2-13— 470--V9'PARCEL SIZE t LAND USE APPLICATION — <br /> OWNERNAME ERNIE COSTAMAGNA 559-269-2032 <br /> OWNER ADDAM P.O. BOX 817 CrrYMATVZIP SAN JOAQUIN,CA 93600 <br /> t CONTRACTOR - HENNINGS BROS_ DRILLING CO., INC. PHONE 545-1185 <br /> CONTRACTOR ADDRESS 3525 PELANDALE AVE. C,rvlsrATw&P M DESTO A 95356 <br /> SUBCONTRACTOR ?� PRONE <br /> i <br /> SUBCONTRACTytORADDRESS_ C1TVISTATEafl? <br /> LICENSE i9C-57 (3 C-61 0D-(19 (3 Other NUMBER 290813 EXPIRATION DATEIle <br /> GEOGRAPH[CALINPORMATION: Coordinates X Y Township_ Range Section <br /> INTENDED UST, Wintalic1Privalf CI Irrigation/Agricultuml ❑Industrial O Water Quality Monitoring 13 Soil Samplinp/Characterization <br /> ❑Public Water Systen± <br /> Ifditre nam Owns. Era y.— ams Cwmt NamM rhow <br /> TYPE OP WORK IN New Welt 0 Replumvent Well R Well AltmboniModification ❑Other <br /> ❑Monitoring Wells) b of wells 0 Sail Boring(.) a at bor ny 0 Gootechnieal s of be0,.p <br /> O Out Or-Service Well 0 Out-0f-Service Well Renewal ❑Crom-Conneolion Repair <br /> ❑New Pum ❑Pump Rcl3lwzmcnL ❑Pump kmair <br /> WELL CONSTRUCTION i <br /> Driving Method IM Mrd Rotary �❑Air Rotary 0 Auger 0 Cable Tool ❑Push Point 0 Other <br /> Propowd Well Depth 200 1 it Excavation_ 14" in dianbocr ❑Open Bottom 19 Gravel Pack/Cmvel Size in diameter <br /> 0 Conductor Casing .in diameter / Conductor Casing Depth ft <br /> i Well Caring Diameter 8 in Thickness/Gsuge/ASTM Sehed 160C L ❑Steel 1E1 Plastic IJ Stainless Steel D Odrer <br /> Grout Seal Depth 100 1 ft Cl Neat Ctnxnl+1^41b bog1J-10gol a ter) 0 Sud Cement sank arm/7 g0 water <br /> ff Bentonite(2411.solids) ❑Manoracorrcr Spec%solids % Name ❑Spxa on Pik 0 SPeca Submitted N <br /> GrattPEaeemeDl Melbod IXPumped O Free Fall ❑Other_ ❑Rcterdant/Aeceletator(name) 41 <br /> PeDr4TAL Installed By ❑Driller I Pump Contractor ❑ Othcr <br /> ❑Concrete PodcsCal Dimensions:Width ft ienglh_`ftThick in ❑Christy Box ❑Stove Pipe <br /> gyp ❑Submersible ❑Turbine 0Othc __HP Pump Set ft Standing Water Levoi R <br /> I HEREBY CERTIFY THAT 1 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. l ALSO CERTIFY THAT MY REQUIRED LICENSE IS 1y <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL �11 <br /> INIMUM,24 HOUR ADVAN NOTICE REQUIRED FOR INSPECTIONS <br /> sfcNED <br /> L4 LE SUPERVISOR DAT, 10-5-07 <br /> c <br /> I AA <br /> + c <br /> p SIL <br /> a <br /> � n v <br /> DEPARTMENT USE ONLY S/ <br /> Application Accepted By —Date (G C Arra Employee IDN L+V If.5- <br /> �9 <br /> GroutlnspectioaBy to ❑ SPECIAL Well Permit <br /> PumP Inspection By Date ❑ WAivER Rece)ved <br /> Constructed Welipep1b rt <br /> COMMENTS <br /> PE SC Received Check#/ Amount <br /> Cad" Info By Cosh. Remitted Date wlee Request a Invoke a Well IDN <br /> `'M—I& 14k, vi I l q ltd 3'xs..ti 0ODnZbLif <br /> END 13-0J_a0s w>:tL PLw PERMrr <br /> In7rA05 <br /> . f <br />