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113645 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304E WEBER AVE3"PL-S9nOC1tTONCA 95202 - (209)4W-3420 NON-REFUNDABLE PERMIT 289 95}7697 FOR INSPECTIONS EXPIRES 1 YEAR PROM DATE ISSUED 3-`�GI h701—L, E JOB ADDRESS Acceas Road CITY/PAP Lodi '/ a CRoa9 STREET Thornton Road APN 055-150-20 Faison SIU 314:14- S OWNERNAME Steve Coldani PnuNE 333-8020 OWNERADDYESe _ 1806 W. Kettleman Lane, Ste. J cmmTAZE Lodi, CA 95242 lA COMPACTOR Delta Stockton Pump PHONe 466-9625 U1 CoNIPACrOBADORESS 646 S. California Street ct wsT.TE Stockton, CA 95203 SUBCoNEMROR PIIUNE "L SUBCONTRACTOR ADORM CrrY/STATE21P f LICEre9E 12 C-57 5C4 ❑0.09 [ICem NUMBER 724778 R"JUATIOri DATE GEOORAHIICALINPORMATION: ComdWler % Y Towmhip Renge_ Seelien_ IMENpED USE ODmosame/Riecic binngstionfAIldc.1tural 0Industrial ❑Water Quells'Monitoring O Sol l Sampling/Charaemnnnnn ❑Public Water Systan vdiv..rt rmni '. nu norm Naii .ahem x TVec Of WORK ❑New Well ❑Replatenumt Well ❑Well Alte elimuModifiuUon O Test Hole ❑C d cr OMouitoring Well(.)__ a.mlwmwraa OSoil Bonin eaehw ora.rl.m OG nenberoftarhP. g(sy edecM1nieei O Well Desu.,tion ❑Out-orService Well ❑Out-Of-Service Well Renewal n ❑New Pomp D Pum dement I9 FumE Ra,air ❑Cmn-Connec:im Repair WELLCONSTRUCTION D01Ung Method O Mud Rotary O Air Rotary O Auger ❑Cable To.] ❑Push Point O Other Proposed Well Depth ft Excs a.Ikn in diameter ❑Open Bottom 0Gewl Pack/Gmvd Sim—in diameter ❑Conductor Casing mdiemder / Conductor Casing Depa B Well Casing Diameter_in Thieknem/Gaugei.4STM Schad C]Sued Su ❑Pluck O Sud t.Sam] ❑other y Crone Seal Depth R ❑Neat Cement 194 lh l g/5-10gal usher) OSand Cement .owknor/7galwater 7A`ham ❑Bentonite Q(%solid.) ❑MAnufkctUmt Spec%sOhdx_% Name ❑Season Pile ❑Spas Submitted Grout Placement Method ❑Pumped ❑FIBeFall ❑ONcr ❑Reantant I Acedenlor(oame) PEDESTAL Insl.11ed By ❑Driller ❑PumP Cmtnolor ❑Oaer O Concrete Pedestal Mmensiou: Width _ft Lengtb ll Thick in OChrivo Bet ❑Stove Pipe Puny O Submersible M Turbine ❑Other Hp 25 Pump Sd 43 ft Sanding Water Lae! 10 It WELLDE3TRUCIO. ❑Open Bolcom ❑Gnid Pack ❑ummed ❑Other Well Diameterin TOW(Depth R beinhm Water h ❑Casingtobe PafuoUmfrom ftUcft Sealing Material O Nee,Cemem(94 lb bag13-/Ugal uwrer) 13Send Canons mcc mux 17 gal water OBemoniMPdlela ❑eemonite(200A solids) ❑Manufacturer SPee%mlids__% Name ❑Spec...File ❑SpeaSubmilled Place"W Method ❑Pumped O Fem Fell ❑Omer ❑Complete wim Muemeom Cep R bclow rade ❑Complete m Exiadng Surrme Pad 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS.AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MUM 24 44OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS SIGNED TITLe CEOpA'rE 11/13/03 uv v 11 EPARTMENT USE ONLY n �� Application Amepcd By Date 1�-10-&3 Area of EmoloymlD. �( Groin ImPmton By Data ❑ SPECIAL Well Permit Pump _ DaR V-li-04 ❑ WAIVER Received Destruction Inspcclim By pate COmdraeted Well Depth ft COMMENTS PE SC Amount Received p to nv.icee We111DR Codes I�h Remitted Ceah Tvice Requeste o is ' -boo D b 0 3 EHD43-02-0O MASTER WATER WELL PERMIT 5/!2002