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#3287 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAI.HEALTII DEPARTMENT 3g4EWERERAYE3cn FL-Sl'OCKTONCA952Q2 - (209)46&342.0 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED to 6 JOB ADDRESS 1155 Gillis Road CITHZIP Stockton 95215 _ Iy CNOSS STREET �. 1TI^ IN S) APN I��-.z 9n-i� PARCEL SIZE I� OWNERNAME Eddie Piazza PIIDNE 466-7118 OWNERADBRESS same CITYISTATEr/JP CONTRACTOR Delta Stockton Pt]IDD PHONE 466-9625 CONTRACTORADDRESY 646 S. Califomia Street CITWSTAI'E/ZIP Stockton_ CA 95203 SUBCONTRACTOR_ PHONE fir SUBCONTRACTOR ADDRESS CITY&TATV ZIP LICENSE 0C-57 0C-61 13 D-09 ❑Other NUM6Ek EXPIRATIONDATE GEOCRAPHICALINFORNMIKIN: Coordinates X Y 'fownship_ Range_ Section- 0 Industrial ection_❑Indusmal O Water Quality Monitoring [I set]Seapling/C'harulenretion H ❑ruble Water SYyStam Ifditfcmni fmm Owna aer YRam ora onxct Nne or n Q� TYPE OF WONK ❑New Well ❑Replec<ment Well ❑Well AlterahoNMadiliution ❑T<sl Hale OOthcr /n ❑Monitoring Well(st7 nun:berorwdls pSoil Boring(s)_ "O'"a'rorma"y ❑Oeulechniwl "um�rarhodnls � �1 ❑Well Destination ❑Out-OPServicc Well ❑Out-Or-Scrvice Well Renewal ❑New Pump 717 Pump R laconem ❑Pump Repair ❑Cross-Conneclion Retail WELLCONSTRU(TION Drilling Method ❑Mud Rotary ❑Air Rmar; ❑Auger ❑Cable Turd ❑Push Point ❑Other Proposed Well Depth H Eacavadon in diameter ❑Open Bottom ❑Gravel Pack/Gravel Sian in diameter ❑Conductor Casing in diameter / Conductor Casing Depth li Well Caring Diameter_in Thickneas/Gauge/ASTM Schad ❑Steel ❑Plastic ❑Smirleas Slael ❑Other Grout Sed Depth It ❑Neal Cement(94 lb/wg/5.10 gr./artier) ❑Sand Cement cock tons 17 gal water ❑Bemonite(2B%solids) ❑Manuleeturer Spite%solids_% Name ❑Speeson Fife ❑Specs Submilted Grout Placement Method ❑Pumped O Free Fall (]Other. ❑Retardant/Acceleetor(neme) PEDESTAL Installed By ❑"niter OPump Connector ❑Other ❑Concrete Pedestal Dimensions: Width__R Length R Thick in ❑Christy Box ❑Stove Pipe PUMP I4 Submersible ❑Turbine C!Other HP lel Pump Set 120 it Standing Water Level 70 IT WELLDMRULTION C3 Open Bottom 0Orayel Peck 11 Created El Other Well Diameter_in Total Depth li Depth to Water Il ❑Casing robe ParfmUed I'nm_R to_B Sealing Material ❑Nest Cement(941h hug/5-/0ga/Purer) EI Send Cement sacked,/7 gal walet ❑Bentonite Pellets ❑Benmoite(20%solids) ❑Manufacturer Spec%solids___% Name 13 Spots on File ❑Specs Submitted Placement Method ❑Pumped ❑Free Fall ❑Other_ ❑Complete with Mushmom Cap R below gede ❑Complete Io Existing Surface Pad I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE W JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MV REQUIRED'C T CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCPFMEA WORKERS COMPENSATION LAWS. INIM UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPF.CT'IONS 313L 2 3 200$ SIGNED TITLE CRO DATE "al ludl,COUNTY ,.-t ilei u{RPICES It DEPARTMENT USE ONLV Application Accepted By le 6.'7-7^'z'O J Area Employee IDR 599'el Gmutlnspmtiuo By 9 Date _ ❑ SPECIAL Well Permit Pomp lnapcsdnnDate�3/�O�L ❑ WAIVER Received I Destruction Inspection By m Date Constructed\Veil Depth R COMMENTS PE SC Amount Che ReceivedDare PI'mlI Invelee M Wall TDM !Codr late Remitted Cash B' Service Re uestR � (7SG ,S CO XU _.L _ 7 G03 Z EHD43-02-006 MASTFA WATEIL WELL PLL MI'T