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#6780 WELL/PUMP PERMIT <br /> SAN JOAQUIN COUI'rtT ENVIRONMENTAL HEALTH DEPARTMEN! 301E WULR AVE 3—FL-S KMN CA 95202-(209)161-3120 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Joe ADDRP3E Kingdon Road 4a?--C.—'V Al p/jfQ// R M, Lodi 9.5Z47-- <br /> ^ <br /> 0 <br /> cTloss Srnerr Thornttm win 055-150-07 pAaceL sac//. 0 1 LAND use wPn.Kwnonx � <br /> OMNeat NAME Ray Coldani PHONE 369-5206 q <br /> OWNER ADDREJR 13199 N. Ray Road CITYSIATi/TJr Lodi, CA 95242 ` <br /> Cowr crow Delta Pump PHONE 466-9625 A�4 <br /> ctmmRAcro "w 646 S. California Street cnvarATizziP Stockton. CA 95203 <br /> soacONrucroR PHONE <br /> SUECONERACInE ADDPE49 CEIVBEATEILD <br /> LNSNEE C!C-57 EIC41 0D4 13 Met NUMEER 72477R EMDAMONDATE \ <br /> GtocRAPWGLINPORMATON: Caurdlaaas X Y TowmMp_ Rau1e_ BecWR <br /> ix—=En llaT__ ❑Dmafi M, e MmplineJAV.1.1 ❑Industrial ❑Water Qoahty Monimring ❑Soil Sampling Ulmse erinnan 16 <br /> ❑Public We.S 2L <br /> Naltra.m rmm .m ymm .ere � er um <br /> TVP[OF Wo RK ❑New Well ❑Replacement Well ❑Well Alu:eniuNModifcauon ❑Other <br /> ❑Meeiroring Weil(s) kofwelb C)Sint BoringOs) s°.bomiF ❑Gntehnial "o.wnnP <br /> ❑Out-0f-San ice Wei ❑Out-Of-Service Well Renewal ❑Cn a�nmtion Repair <br /> ❑NeW Punp Elftw Reptiecinew, ❑Pmp R <br /> WaL CONsrnocTON <br /> DIOS,Method ❑Mud Rotary ❑An Roury ❑Auger ❑Cable Tool ❑Push Paint ❑Other <br /> Proposed Well D di ft EAawdon in diameter ❑open Bonn. ❑Gravel pack/Green][Six in diameter <br /> ❑Cod.W Ching in diameter / Conduc..Casing Depth ft <br /> Well Casing Nam ter_in Thlcluiea/Gsuge/ASTM Schd ❑Seal ❑Plastic ❑Sunmas Steel ❑OOH. <br /> Grout Seal Depth ft ❑Nat Cement(94 N bag/5-10gal aede) CI Sand Cement sack Mir/7gal Water <br /> ❑Bemniu(20%senfids) ❑Maufsew.r Spec%solids % Name ❑Speer on Fik ❑Specs Submiud <br /> Grout Pau.ent Method ❑Pumpal ❑Fm Fall ❑O her ❑Reudent/made ma(name) <br /> I.taied BY ❑Driller ❑Pump Conuneua ❑ Other <br /> ❑Concrea Peds sol DI.ensb.:WM[h ft Length_fini.ki. ❑Chriay Bas ❑Stove Plpe <br /> P—P P E Subm ble ❑Turbine ❑Other HP15 Pump Ser 69 ft Standing we Level 10 ft <br /> 1 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS I <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 20 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> sloNeo Trrlx CEO DATE 04/28/06 <br /> IN G <br /> VR <br /> eD�PARTMUSE <br /> P/rrONLY <br /> Appliadon Aaptd 0Y� M^ 0• S� Date <br /> Ara EmPloya IDk <br /> Grout hespoesm BY u ❑ SPECIAL Well Permit <br /> ❑ WAIVER Received <br /> Coeanaad Wtll Deptb B <br /> COMMENTS 1/e k Cd.�F la fj�7t iH1F�ft�Y—F <br /> PE I SC RaWvedCYn <br /> Annual PermiH <br /> Cad. la(o B • Reied Wer Servke uaa, Invekex Wall NO <br /> !3 oh 4 woml <br /> PMUaI mM6 WELL PUMP PeUCT <br /> mvmas <br />