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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEFARTML 304EWESERAVE3°FL-STOCRT0NCA95303- (209)4 3420 <br /> NON-REFUNDABLE FERMI CALL(209)9517697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoIADDRESS 15800 GRANT LINE RD. CmrLiP TRACY 95.9.H3i �. q <br /> CROSSSTREEr HANSEN RD. APN2-09—/9O-07 PARCEL SITE 36"y I.ArN USE APrLIGT E <br /> O"M NAME MANUS; AMARFI <br /> Pxone Rafi_4091 <br /> OwNENADDREs P.O. BOX 1086 cmrsrAT r TRACY. CA 95378 <br /> CoNTBAcroa HENNINGS BROS, DRILLING CO. . INC. PRONE 545-1185 <br /> CoNrvacmB ADDpESs 3525 .PELANDALE AVE. CreveSTATEMir MODESTO. CA 95356 <br /> NUECONfEACfON PHONE <br /> SUICOre F.A I ADDRLS4 Crrv/STAT r <br /> LIEENEE III C-57 13C-b] O D-09 ❑GdIG NUMBLR 2 Q ITR 1 E WIEATWN DATE <br /> GeocEArxluLlnwRAunon: Caadinata X Y Township_ Range_ Seado._ <br /> INTENDED USE Wmestie/Private O lnigation/Agnculnusl Dindumiai OWaterQualityMonitoring O Soil Sampling/Chamcteriauon <br /> O Public Water Sypst1eemm <br /> IfdIM tfmm(Nv . vow M amw <br /> Twc OF WORK 0 New Well XT Replacmtat Well 0 Wall Aheralign/Mdificvti. 0 Tat Hole Cl Other <br /> D Monitoring Wallis)_k of wells 0 Soil Borings) a°Troriep 0 Gaotmhaieal xorlarug <br /> 0 Well Destruction 13 Out4XSemice Well 0Out-0gScrvice Well Rmewai <br /> O Naw pump O Part,Replactureat O Future R O CrossComtation Repatr <br /> WELL CONMUCDON <br /> Drilling Methd ❑Mud Rotary 13 Air Rotary EI Auger 13 Cable Tool ❑Push Point C1 Other <br /> PrepmeA Well Depth 4601 ft Esovati.n 12" m dianme, 6 D D Open Bonam IXGravcl Pack/Gravel Six in diamete <br /> OConducmr Casing indiarrcter / Cond.WCW.g Depth ft <br /> — —WaLLGYog._.➢ramera_ ,lp...Thickcc WGmge/ASTM Sched 160CI. ❑St«I X]Plastic 13 Stainless Slat 0ONa - (� <br /> Grout sew Depth 2001+ ft ❑Not Careent(94 lb bog 1540gol wore). ❑Sand Cement as kms/7 gal water <br /> yEKBentonk.(20%suits) ❑Mmufeeturar Spa%solids_% Name OSpec,m File ❑Specs Submitted p <br /> Grout Placement Method [)(Pumped ❑Fra Fall 13 Other ❑Retardant/Acalentor interim) C' <br /> PEDLsrAL Installed 0, ❑Driller Y7 Pump Contract., ❑Other (` <br /> ❑Canoe.Pdetal Dimmabn.: Width ft Length R Thick in OChW OStve Ppe <br /> Sm <br /> Pump 0Submmible ❑Turbine DOther HP_ Pmp Level C <br /> R <br /> WELLDFEIEffit X ElOpen Botmm ❑Gravel Pack 0Uncad ❑Other <br /> Well Diameter_in Taal Depth R Depthto Weer R ❑Caing to be PerfonW from_ft to_ft <br /> Seating Material O Nat Cerement(9415 bag/5-20gal ware) ❑Sad Cement Back mu/7 g.]water ❑Bentonite ME. <br /> O Bmmnite(2W.m]ids) O Manufacturer Spa%solids_% Name OSWson File OSyar Submiud <br /> Placement Mef uml O Pumped 0 Fra Fail 0 Other <br /> 0 Complete with Mushroom Cap ft below grade 0 Complem to FEuting Surface Pad L <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN NNvv <br /> JOAQUIN-COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIIIED.LICENSE IS 1'r <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> 'MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS ( <br /> slum .� b SUPERVIS R DAreAUG. 20, 04 <br /> a <br /> Set <br /> n <br /> n <br /> ! S eg <br /> .------,.-.n- rvrar.'Rp-•n,..- 'DBPARTMERT O _ s- <br /> Appliatim Acceprcd By Date 9 -7 O a <br /> Ar2/6 5mploya IOk yl 5(o q. <br /> Groutinspaoat By - _ _. naa-- - ❑ SPECGL®Pd1 YIP�If- <br /> PumpInspectionBy Date ❑ WAIVERRecelved <br /> Destr ction Inepeetim By Data Construetd Well Depth R <br /> COMMENTS Q/e7 (o- � (d dJSL✓ rov <br /> ♦�n>l, <br /> 776 EI2 w 'eawa, <br /> PE SC Reeelvd Antennae Data P. v Invv1ee0 W40 IDS <br /> Codes Info By ash Remiftad SerWaR vert! <br /> ef3- IPv D 1�yj 1.S�z�s--tea O �r a (0 <br /> ENp O�idn6 �� 6 �1,,n 3.5 TG( JOS44 (a,e1 6 6t ( E0.WA WE yrE0.k1_ n <br />