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WELL/PUMP PERMIT-r-41- SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED JOB ADDRESS 17000 E. HWY-120 PARCEL SIZEIAPN CITY/ZIP RIPON, CA 95366 OWNERNAME THE WINE GROUP ADDRESS P.O. BOX 897 CITY/ZIP RIPON, CA 95366 PHONE (209) 599-0420 ] CONTRACTOR NOACK. ADDRESS 4500 E. F'REMONT 5T CITY/ZIP STOCKTON, CA 95215 PHONE {:209} 948-8817 GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER INSTALLATION: lel WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# TYPE OF PUMP: ❑ NEW rXREPAIR H.P. 5 DEPTH PUMP SET 12 6 FT. FIRST WATER LEVEL 42 ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA M1 DOMESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASING TYPE WELL CASING DIA ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUT SEAL DEPTH SPECIFICATION ❑IRRIGATION/AG OTHER GROUT BRAND NAME ❑MONITORING 24 HR N CDTj C E GROUT SEAL PUMPED: ❑YES ❑NO �• 13CHRISTY BOX ❑ REQUES-TEU STOVE PIPE F0�R A L CONCRETE PEDESTAL BY DRILLER: 13 YES 13NO r APPROXIMATE WELL DEPTH 1 921 N_S P E Q_1 1_(DN s r { PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 1 SIGNED: D I.0 K TAYLOR TITLE: RETAII SALES DATE: 5-26-00 i Ila I r I ,r • r DEP RTME ONLY Application Accepted By_�("' ��`— ^��/ Areal C� i Grout Inspection By Date Pump InspectedP DateGZ�C Destruction Inspection By ate ,AUL COMMENTS: SAN JOAQUINCOUNT UNT IC HgjH NNlEKZAL ri PE SC AMOUNTE RECEIVED DATE PERMIT/SERVICE REQUEST# WELL ID# CODES INFO REMITTED CASH BY