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v , <br /> ' WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ,p <br /> *Tffi <br /> 304 E.WEBER AVE.THIRD FLOOR STOCKTON CA 95202 (209)468-3420 //. C <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ` <br /> JOBADDRESS 17667( pE.. LibertyRd. � ,PN ;) 09-080-02 <br /> CnyrLIP cya l - PARCELSTLE <br /> OWNER NAME watts vineyards ADDRESS 17010 Locust Tree Ln <br /> cITYizIP Lodi, 95240 PHONE <br /> CONTRACrORPuryiance Drillers.Inc. ADDRESS P. 0. Box 64 <br /> CITY/21P Linden PHONE 209-887-3554 C-57 LICENSE# 377923 EXP DATE 7/01 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y_ TOWNSHIP_ RANGE_ SECTION <br /> TYPE OF WELL: EEA NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: §? NEW ❑REPAIR H.P. 150 DEPTH PUMPSET FT. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL W OPEN BOTTOM WELL EXCAVATION DIA 2 2_ CONDUCTOR CASING DIAnj a <br /> ❑DOMESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASING TYPE steel WELLCASINGDEA 16" <br /> ❑PUBWCJMUNICIPAL ❑DRIVEN GROUT SEAL DEPTH 320 SPECIFICATION • 250 <br /> ©IRRIGATION/AG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROUT SEAL PUMPED: )YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES ❑NO <br /> APPROXIMATE WELL DEPTH 650 <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY X AIR ROTARY AUGER CABLE_ OTHER � <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 C-57 LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSATION LAWS. <br /> IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> sIGNEri Vii: 4f/ L��i'%!-sC- TrrECorporate Secretary DATE 4/9/01 <br /> n <br /> YbiCkA <br /> J 1 <br />