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/ <br /> MM SAN JOI.Qutn COUNTY ENVIRONMENTAL HEALTH WELL PUMP PERMIT <br /> tix DePARrM¢NP 3g4E Weaea Ave 3'0 NON-REFUNDABLE Pt-STocRTonG952Bx - <br /> PERMIT }7FOEIS e6&3dx0 <br /> CALL 209 95697 R INSPECTIONS EXPIRES 1 YEAR meow DATE ISSUED <br /> JOE A.DOREa 26955 S. HANSEN RD. CyryZp TRACY, 95376 <br /> — CROSS STREET SHULTE RD. ^ _ <br /> AMKr�� I/007 PARCEL y <br /> OWNER NAME DAVID WEAVER pHQME 836-0501501 hGf <br /> oxmea ADDRESS 26955 S. HANSEN RD. CTYSTATVLIF TRACY, CA. 95376 <br /> — COM OR NOACK <br /> PHONE 946-8817 <br /> CONTRACTOR ADpRP$ 4500 E. FREMONT ST. LTrr7btA,rtZP STOCKTON, CA. 95215 ryy� <br /> BUBCOMIUCPOR PHME .l <br /> MM SUIWONTMCPORADDRESS CMJSTAT1Z&lP <br /> LIEENUE IAC-57 0 C4 0D-09 ❑Other Nu LASER EXPIRATIONDAIE 05 <br /> GLOORAPHWALINFORMATIOn: C¢¢rdleeW X Y T¢wmhlp SeeB¢n_ <br /> INTENDED Use Dornnti¢/Pnvam ❑IrripdoNAgsieuletural ❑Indutdal ❑We-Queliry Monimring ❑Soil Smpling/Ch Nueterimion <br /> — ❑Public Water SyyIDmmm <br /> NdiHenaflmn Owae- arae <br /> � m <br /> TYPE OF Wow ❑New Well ❑Replecamem Well ❑Well AltmtioNModifianion ❑Teat Hole ❑Osber <br /> ❑Monitunng Weil(¢)_ '"fief 0"14 ❑Soil Boneg(¢)_ na .fwr' ❑Geeteehniul <br /> — o Well DeRucdon ❑tAt-0f-Service Well ❑Out-0f-Service Well Renewal 's <br /> ❑New Pump ❑Pump R teeenent KI Purnp R r 13Cms Coenatiao Relneir <br /> WPIL CONSTRUCTION <br /> Drilling Method ❑Mud Rmq ❑Air RuRAq ❑Auger O Ceble Tool ❑Push Point 00,W <br /> Pro,"Well Depth B Excavation in diameter 0 Olden Bottum ❑Gravel Pack/Gravel Sin in diameter <br /> r ❑C uctur Cuing iudiametr / Cmdueuor Caning Depth fl <br /> Well Casing Di¢m._in Thickeeea/Geuge/ASTM Schell ❑Steel ❑PWtic ❑Sminlae Steel ❑Other <br /> Grout Seal Dep@ R ❑Neat Cement(94 lb Aeg IJ-/Ogul water) ❑Send Crmat aacl,mit/7plwater <br /> 0 Bentunite(20%eolide) ❑Muuficmrer Spee%solids Name ❑$pets on Flle ❑Specs SubminM <br /> Gmut Pmcemera Method ❑purnped ❑Frac Fell ❑Other ❑RemNam/Aaelmmr(time) <br /> r PmrsrAL Inemlled By ❑Driller O Pump Cantracmr ❑Other <br /> ❑CDncum Pedeami Dimeui¢u: WidN B Length il Thick ❑Chrkty Boa ❑Stove Pipe <br /> Pum. 91 Sub.,Ik ❑Turbine 0 E Net HP1L� Pu rapSet <br /> a0 fl Standing Water Level 216 It <br /> WLu.DeSTRurnoN 0 O eotmm ❑Gravel Pack ❑UncuW ❑mer <br /> — Well DianN¢r_in Toul Depth B De�thm Water fl OCadngmbe Peftneeddfiom_R mfl <br /> Sealing Material 13Nmm <br /> Cent f944 lD bag15-/0gafwuer) ❑Send Cemew Anel,mu/7 Ed]wam ❑Bealordk Pelkn _ <br /> ❑Benm ru,QW.solids) ❑Mmufacmm Spec%solids_% Name O Spas an HIe ❑Specs Submived <br /> Piecemeu Method 0 Pumped ❑Fra Pall ❑Other <br /> ❑Comylar with Mushroom GP flbebw grade 0 rel mExiting Burflne Pad <br /> — I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLIGTION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,BTATE LAWS,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 /> WORKERS COMPENSATION LAWS. <br /> MI MUM 24 OUR ADV CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> — SIGNED T'mr RETAIL SALES DATE 30 NOV. 2003 <br /> r <br /> r <br /> Y T <br /> r <br /> H Pi AD <br /> PARTMENT U NLY _`` [7� <br /> Application AaepHE By Dam Area ! Employee lDN <br /> Grout Inspection By Den ❑ SPECIAL Well Permit �F <br /> Pumpinnpanon By Date ❑ WAIVER Received <br /> Destruction hernuttim By ` Dan ConMructed Well Depth R <br /> COMMENTS <br /> PE ReeeivW hee Aemuat PermiU <br /> r <br /> Coder lel. B Cult RevelHed Ate gervie rR untM levyirep W¢II IDN <br /> O a �3vso L e <br /> ` EHD43-0L �¢' MASTER WATER WELL PERMIT <br /> Ivhrzogx <br />