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#4234 WELL/ PUMP PERMIT SAN JOAQNN COUNTY EWIRONMENTAL HEALTH DEPARTMEM MM E WE9ER AvX 3-FL-STIIXTON CA 95243 -(209)968-3!20 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED J09 ADOttcts _ / 3gS0 A Thornton CITY/LP Lodi n CROes STRIPY ii ail, APN 055-150-07 PARCELSHE //.,0/ p O FRNAME _Ray C01dani PHONE 369-52C6 I C.AYDRE'SE 13199 N. Ray Road CITY/STATVZIP Lodi- CA 95242 _ CONrRA R Delta Stockton Pump PHONE 466-9625 CONfMLTOR AODRER4 646 S. California Street CnrriSTAT ZIP Stockton, CA 95203 SUItcoNrucroa PNONg W SUBCONTRACrOR ADM", Q•I'Y/ATAI,FfLIY }� LICEN ❑ L aE nC-57 dIC.61 0D-09 Other NUMseR 72477$ E%PIMnON DATI. I GEOORAmK:ALIrkPORMATION: Coardieores X Y Tawnship Raege_ Section_ INTExDED 115E ODomotidPtivaa Irtiguiov/AgncWmml DlrWustrial OWater Quality Monitoring OSoil Semplinglcho.o.iadon �a ❑Public waw S trdlvemn rAm✓ m.- .m E.m„ .ma an as.w sae TYPE OI WORN 0 New Wall O Replecemol Well ❑Well AlscretipNModificegoo ❑Tot Hole ❑Other OMonia gwdl(s) numeerafw<n. pSoil Borin s '--bon—® OCtouttlinital .omem wwdna ❑Wdl Destmcdon DOueAf-Soria Well DOuaOFService Well Removal ❑New ELT ❑Pump Replacement EXPI.p kt,oi, 0 C.CraI Rciamir WELLCON.srk r ON Drilling Method 0 Mud Emery 0 Air Rmary 0 Augm 0 Cable Tool 13 Nth Poon: 0 qhs Proposed WNl Depth R Excavannn in diameter 13 Ow Bmwm [3 Gravel Pack/Grovel Sim is diameter 0 Cor d.ho Casing in diameter / Conductor Casing Depth ft We11 CmYn9 Diameer_ n Thiekne /Gauge/ASiMSched OSael ❑Plastic ❑Sainless5tcel 00tha, Grout Seal Depth B ❑Neat Cement(94 16 hag/3.1 ogal weer) ❑Sand CCNlertl .,tock mix/7 gal water 0 Bentonite 12(a/.milds) 0 Manufunuer Spec%solids_% Name_ 0 SPscs m Rte 0 Specs Submiaed Crout Placement Method 0 Pumped 0 Free Fall ❑Other 0 Reurdant/Accekratw(tome) PED.W.I. !malted By 0 Driller 0 Pump Contimew 0Other 0 Concrete Pedestal DIMoslaiv Width_R Lengrh t Thick in 0Christy Box 0Stora PI Pum, O Submenble 0 Turbine D Other__ HP_ PUMP Set ft Sanding weer Lcvcl R W eu DErraurnoN ❑Open amrom ❑Grovel Peck ❑Unuted Dottie, Well Diameter in Toa]Depth R Depth to Waleft 0 Co],to he Perf rstad from a to_R Somalia,Material ❑Neu Cert(9916 bag/J.ldgaf waxer) OSrd Cement aacJmdl7galwear O Bentonia Pellets IlIke—he(20%solids) ❑Manufacturer Spec%solida__ % Name ❑Spieson File ❑Specs Submitad Placemeal Metiwd ❑Pumped 0 Free Fall 0 Other- 13 hs0 Cornplea With Muds mom Cap R below gado ❑Comptes m Existing Swfaw Pad 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES Al. REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICEISE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINI M Z4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 SIGNED Tartu CEO DAT 04115104 P Old Td µ H 1 14-1 DEPARTMENT USE Y Application A¢eptel BY Dere e3- Arn / EnsplDYec IDq Q� Grout]vspstinn By /' Dare / ❑ SPECIAL WlII PCTRIII Pump lnspcedon By - Date V 710�L ❑ WAIVER Received Desw<tion Imp¢lion By Oate Constructed Well Dmpth ft COMMENTS PE aC Recdved Ch Amount Dtlz Pit if/ Invoiced Well lDp Codn Info B oh R<misttd Servke Re ueatp O 0 /loD3 t Dai o 00 EHD 93-02-006 MASTER WATER WELL PERMIT 1216/2002