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+1 73ofa3 WELL/PUMP PERMIT F .-e,. r. - <br /> SANJDAQUM Courcrr Ervvmum�rcv.HFALTa DeeARtRRNr 600E.Maly StrM-Suparron G95T0'♦v'j2g99a6g:M30 -- <br /> NON-REFImvAau PERMIT CALL(2091953-7697 POR INsP molls c.XPTRES I YEAR PROM DATE IssuED <br /> �-T� R <br /> JOS ADDRESS /SG.Sa LOnwIE i F-f-r42dn-0 c�.n.Mx, ESC t-caN 9S310 <br /> GCGSSTRERT Vaa A1-CC-- JEcd O A _a2 �efO-Or PA¢m.Ssu,�L Use Awlac ronx i <br /> QwneR NA�s ;�nHn1 /1'L. V/E/RA 7R PRue¢ 838- 3"y, 1 <br /> OwNnt Annwss ��' 03S 6. tome Mk6w- CITT/STATTIllL 6ZtZ,+ o , C.4 9S'3.;L(3 <br /> CONTRACTOR Delta Pump Paorc209-466-9625 <br /> cormAcroaADDaess 646 S. California Street CTTv/SrAT Stockton. CA 95203 <br /> SOBCONTR&Mit PRONE <br /> SUBCONTAACIVAADDRFSS CMBPA]VLIP <br /> Llc Sm 0657 42661 0E,09 ❑oder NDem 724778 EeemAnoNDATe 8/08 <br /> C <br /> czocaAe®cAC lrvmRatAnorv: caoraiww X Y Torwahlp RauPe_ Sectlan_ <br /> Imarvaen Use ODomuvGPtivam p(Dgadan/A&dowmml Omdestdal ❑water Quality Monitoting O Sea sampling/Chmacterimtion <br /> 0 Public waters stem <br /> aa�am scm m m® ema C.,Naaccc - <br /> TreE OTWoRA ONrn Well OReplaccomon WW ownu AltemdmAleifil OOd« <br /> O Monitoring Well(s) xofwells 0Soil Bmmg(s) aefedo, 0GeoteehDiml a°fb�ma' <br /> 0 OmOf--servi«Well 0 tmt Service Well Recomal O Cros.C....d.Rc mr <br /> ON.Pump 0 pum,Replacement Xt.R Eno. <br /> W=C,msrauMeN i <br /> DNllmg Method 0 Mud Ronny Cl Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Ocher <br /> Proposed Well Depth 8 Recaefi. in diameter ❑Opea Bottom OGravel Pock/Qtavai size indiamer« <br /> ❑Conductor Ceaing indiamet« I Conductor Casing Depth 8 <br /> Well Casing Diammor m Mocknea4Gaug,/ASTM Schur 0 Steel ❑Plastic 0 stamleas Steel Omer <br /> Grout Seal Depd ft ❑Nem Cement(94 lb bag/5-10gol water) 0sand Contact aaekmk/7gWwehr C <br /> O Sentence(20%aolide) OManuSchu«Sp«%solids_% Name OSpeeaon File ❑Spas9nbmiaed <br /> Groot Placement Medal OPumped ❑Fra Fell ❑OW« ORehMavt/A«elaramr(namo) <br /> $,ppgAL Instte.G By O Ddiler ❑Pump Comm enor O Oder <br /> O Coaecent Pedestal Dimeneieu:WMth ft Lagd ftThicJc w OChrldy Boz OSmm Pipe <br /> HIIff OSWmenlbk Turbine ❑Oder HP O Pump Sd flShnaivg waarl.amol 8 <br /> I HEREBY CERTRrk'TIIAT i RAVE PREPARED THIS APPUtAnON AND THAT THE WORK WHd,BE DONE M ACCOBDA]4 6 WITH SAN <br /> JOAQM COUNTY ORDINANCES,STATE LAWS,AND RIMES AND REGULATIONS. I ALSO CERTIPY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND AtTPVE WITH THE CAI.O'ORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM M COWL CE WITH AIL <br /> WORKERS COMPENSATION LAWSw <br /> MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> sacrveD /Lt / Tine CEO <br /> W <br /> i <br /> e <br /> A UI <br /> N E <br /> ENT <br /> E AHTM ENT U E NLY <br /> Appli«tiw Accepted ate Area Bmp1oY«Tp�ot�.f <br /> GrommspechoDBy Dare�� O SPECIAI.WeIf Permit <br /> Pumpluspection By Dete ❑ WAwEa Received <br /> Coaamocmd Wall Depth <br /> c0 O <br /> G <br /> PE SC R«ehea Amonnt Uah Perms✓ IlVpl[ex weAIDM <br /> odea Into B Cash Remitted rviceA ncetp <br />