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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTti DEPARTMENT 1865 EAST HAZELION AVENUE • SIOCK70N CA 95205 - (209) 466-3420 <br />— I 4nno1 oe•r_7e07 eno lucocennue EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSS STREET <br />NAME <br />ADDRESS <br />DREW & HEFFNER WATER WELLS 8 PUMPS-- PNONE 559 645-2483 <br />ADOREs9 26452 AVENUE 17 1/2 _ CITYTSTATEfdP MADERA. CA 93638 <br />PHONE -- <br />SUBCONTRACTOR <br />_ <br />4900 V06��(lj tl (q/- tw- E FIT,— LODI, CA95242 _ <br />API 055-020-028. Oe PARCEL SIZE 1 2.0 LAND USE APPLICATION s 612 <br />GRINDSTONE JOE ASSOCIATION PHONL (650) 279-0242 <br />1029 N COUNTRY CLUB BLVD. Cm)STATFILP STOCKTON, CA 95204 <br />SUBCONTRACTOR ADDRESS CtTY/STATE1zIP <br />(UCENSE ✓C-5/ C•61 D-09 _ Other NUMBER 1003754 _-EAPIRAnON DATE 05/31/2021 <br />DOMESTIC WELL SAMPLING: ✓Genera( Mmeral,,Colitorm Bacteria (4391) %/Dibromochloropropane (4392) ✓Arsenic (4393) <br />INTENDED UsE r—m Si --1 rrvate IrrlgatlonlAgriculturalIndustrial — Water Duality Monitoring Soil. Samplig/Characienzatior — <br />PuWic Water jysiem <br />11 On—. 1— Ow»n Wxei Syuee» Nwme GKealt NPYru• n. Phwie Nurhm <br />TYPE OF WORK New Well VT epiacement Wall Well <br />Monitoring We0(sl e M wells Srnl Bonnq;u _ <br />s ni ulrmW. (iP.010P'1nIC8l _ . __ _ e o1 en»yr. <br />Out -Of -Service Well Out-OfSemice Well Renewal Cross -Connect,- Reoair <br />n <br />V New Pump YUmp rtap4ewmiarn <br />WELL CON3TRUCTION <br />Cil <br />Drilling Method ✓Mud Rotary Ai Rotary Auger Cable Tool Push Point Other N <br />200 h Fxeavabon 12 m diameter Open Bottom ✓Gravel PawGrsvel Size uooa.r, 1Ts in diameter A <br />Proposed Well Depth j N <br />Conductor Casing in diameter t Conductor Casing Deoth ft <br />Well Casing Diameter j§— in ThK1('auge/ASTM Scnerl 5DR /7 Steel ✓Piasoc Stainless Steel Other_ -_ <br />Grout Seal Dept .at Cement , 9.116 W/5- 10 gar water) ✓Send Cement _ 103 — _sack rnubr gal waver <br />Sentortte 120% sOkdsl Other ------ '-- <br />lGrout Placement Method '/Pumped From Fall Other Retardant 1 Accelerator mama) <br />PES' Tri In;taged By--Drller Pump Contredor� Other —� <br />Concrete Pedestalybimensions Width a h Length .t !t ThO __i,n Christy Bos Stove Pipe <br />ptwP Submersible T HIP Pump Set 45 It Standing Water Level N <br />1 H THAT I VE PREPARED S APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />ADN COUNTY DIN CES. STATE LAWS, D RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTT THE CALIFORNIA C NTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENS O LAWS. <br />MINIMUM 4 HO ADVANCE I ' REQUIRED FO%R� NSP}E�C�TION�S-- PLEASE CALL (20 95 7697 <br />Trtl l: V DATL I Z <br />I, I 1 T I <br />Appj. inion A"cpted By <br />Grout Inspection By <br />Pump Inspection By <br />Soo Bor" Inspection ey <br />I <br />- -- AYMENT <br />- RECEIVED <br />-I ' -- U 2 5 2019 <br />JOAOUIN COUNTY <br />v4ROMMENTAL <br />IEALTI4 Or PARTME N 1 <br />RTMEN0Z. <br />E O Ly <br />t)ato. _ / /. AmaDalt// / PECIAL Well Permit <br />nate _- WAIVER Received <br />I DDeeept�thhC_ .-&= �- t <br />Tr <br />IL <br />rr-YY vv __ - —F sV <br />,o1ce p Well Will <br />WELL iPU4r }ERPOF <br />7/30/9. /Qfk--&c4v ur;AxAr44r $ - 14*kirfaf-- l /afjw-ww 771* W&kV- <br />60 l(, ' a./ -a 10. 3 SAC <br />