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,.� WELL/PUMP PERMIT <br /> irJ SAN JOAQmn COUNTY ENVIRONMENTAL HrwW OVART@Nr 600 L Main Street-STOCHTON CA 95202-(2M)46E3420 <br /> NON-REFUNDABLE PERMIT c ,s(CALL 122009 9$$-7697 FOR INSPEC710115 EXPIRES I YEAR FROMATrE ISSUED <br /> Jon Abater" 7 1 O J. ��45�) „ C /Zte `J 3 <br /> if <br /> GRQSn STR[R 1✓ AW!4- 9L� 103�/3"PARCBL$blj�L�LAeID DEn AeI1JCAl10NM <br /> O"ERNAME -S eM <br /> O- oun aln floupl L PHONE <br /> ON'NERADDRESS CS ISTATE/ER <br /> COMMCNR sfExplorGAICIrN <br /> jj��P�R/O�n� <br /> ConTMLTORADDRlBe <br /> Ec), e 3 CEIY/ftATE/rW L� coa a S go <br /> SUBCONTRACTOR O`1 ('y1 Q DPMO! C�jD <br /> SUBCONTRACTOR AO �W� IJ.J)'eltf). l iY-" iVe A CrrviSTATV/le .`I lJ J <br /> LIC[Nsa 6-57 0 C4 ODd9 13 Other NUMaaR ERm]IAT]ON DATE <br /> i GeacRArRsuLInFORMAnon: COordlnatm X - Y - Township_ Rug._ Settles_ <br /> ImNDUUBn ODomeedc/ nes. O DriptionlAgriculturel 137 d.trial O Wmm Quality Monitoring Weil SamplinyViberectedades <br /> O Public Water System <br /> tfddl nfmmO ow: .Mo rnse am. nn .meu me <br /> TM OF WORK' New Well ORWlaument Well O Well AlterationrModifiafim C)DOW <br /> ❑Monitoring Well(s) Mofwells ❑Soil Boring(s) s°sb°n°r 11Grevoth ' <br /> ❑Ou.ofService Well 0 Out-Of-S.A.S.A.Well RenCt..Conauc epair <br /> Cl New Pum 0 Punng,R-lacemeot O R air <br /> WELLCoNSTRUCRON /1. T <br /> Drilling Method Mud Rotary ClrAsyiir Rotary VA. n 0Cable Tool 0 N Point juOWer CP 1 <br /> Proposed Well Depth `tI'� ERnvetion _iu diameter (3 Op.Bono. ❑Gavel Pack/Gaud Si. in diamater <br /> O CeMYnor Coring in diameter / Conductor Coring Depth ft <br /> WA Coring Diameter in Thic slGaug STM Schad ❑Steel O PWfic ❑Staivleu Sued D Other <br /> Giom Ned OWth fl Neuf :e941hbagy J-/0V1uare) Cl Send Cement sackmrs/7galwatm <br /> Batooin O%solid.) O adorer Spee solids_X Name OSpeeses File OSpec.SubMned <br /> Grout Placement Method Free Fall OOlhar O Retardant I Aceduraw(neme) <br /> P6D[sTph Imulkd By O Driller 13Pump Connector 0 Other <br /> ElCeserde P.desW Dim.ntlonc Width ft Length ftThick In ❑Chrlsty Bos ES ve Pipe <br /> PUMP OSubmtsible OTurbine DOMer HP Pump Sot ft9tanding Water Level 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. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS ENSA LAWS. <br /> INIMUM 24 HOUR ADVANCE NOTIC� SPy TONS <br /> SIGNED Tn ,VQU (IbDDA-re -'T-/3_ <br /> -D' <br /> PAYMENT <br /> 1 III RECEIVED <br /> r 11,1111 <br /> JUL 1 3 2007 <br /> • - JOAQUIN COUNI <br /> ENVIRONMENTAL <br /> EALTH DEPARTMEN <br /> I INTO <br /> RTMENT /USE O LY <br /> Application Acaxpta&RK7 Da 1 Area En I.M IDM <br /> Grout Impccfian By Data ❑ SPECIAL Well Permit 1/ <br /> Pump lnspegioa By Dew [3 WAIVERReceived <br /> Constructed Well 1,Upth it 1 q <br /> - COMMENTS X19 Ces�re.z% _s+If- OvY- <br /> ���a> <br /> PE SC Received Cheew Aresont ParmiU <br /> Caere ]or. B Coati Retained Date SWJ. n <br /> ue0 InvoleeM Wall IDM <br /> ,V T2 051-2 <br /> "LLPIRNPERMR <br />