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97215 WELL/PUMP PERMIT <br /> SAN JOAQUIN COIR?r ENVIRONMENTAL HEALTH DRAmevurr 30eEWEBERAVE3"PI.-BIOcIRQYCA95203 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AOORres 4580 W. Highway 12 CITV/EIP Lodi 95242 <br /> �a.os' <br /> CRoss STREET N. Ray Road APN PARCE Stu LAnD USE APn.Ic,LnOng <br /> OWNER NAME Don Phillipa PHONE 368-1687 <br /> OWNERANNIEss 880a CTY/STAT P <br /> ComnAcmat Delta Pump PHONE 466-9625 <br /> coNraACroRADOREgs 646 S. California Street crtrtsrAT vp Stockton. CA 95203 <br /> SUBCGN 121rOn PHONE <br /> SuecoNrRACTORADDRM CITY/STATEMIP <br /> LICENSE OC-57 DLC-Si OD-0 E3 Other NUMBER 724778 EXPIRATION DATE <br /> GEDG AMICALInFDRMATION: Coordlnakr X Y TowashlF It.Dge &cdun <br /> INTENDED Us[ 2J Donlcslic/Privau O lrrigalJONAVicultuTl Olndu-Incl O Water Quality MOnilonng O Soil Sampling/Charataimum <br /> ❑Pubi'w Water�5yy9s <br /> IrtiRNen fm W .w SyvSe ame onm Narww r <br /> TYPE OF WORK O New Well O Replacement Well O Well Al4 tioNModifiuoan O Tae Hole G Other <br /> O Moniaring WCII(-) Nofwells ❑Soil Boring(&) Idbar,; OGeotahnical .0borMa <br /> 0 well Drsuucow a(Nt-of-Service Well ❑Out-Of-Service WWl Rw <br /> enel Pull pump- instal <br /> 0 New Pum 0 Pum R lacement Pkmp R O Cross nation R <br /> Drilling <br /> WEL13 MOW MNhod ❑Mud Rotary E3 Air Rotary E3 Auger ❑Cable Tool C3 NA Point 0 Other <br /> ProposM Well Depth A Eaawuon in di.w ❑Open Bottom 0 GnoId Pak/Gnvel Sim in diameur <br /> OCorduear Casing indiamerm / Conductor Casing Dapth R <br /> Well Cadog Diameter_ n Thirkwa/GaugdASTMSched OSoci ❑Plastic OSlainkas Stmt 0Other <br /> Grout Seed Dcplh A ❑Nast Canent(941A bag/3./0gaf worm) ❑Sand Cemem .pock near/7BRI waW1 V� <br /> O Bmanite(211X Wide) OManufIctuoa Spec%mlids_% Name ❑Spa-on File ❑Specs SubmitlM ^—lam1 <br /> Grout Placement Method 0 Pumpal 0 Fra Fell ❑Other ❑Rcurdent/Accelaaar(name) V <br /> PEDESTAL IndNled Br ❑Drilla 13 Pantie Conlrawr ❑Other <br /> O Concrete Pedesul Dltneaaiom: Width fl Length fi Thick is O Chdny Bos O Slovt Pipe <br /> Pune El Submersible C)Turbine 13 Other HP 1 Pump Sa 84 6 Sanding WMer Leoci 22 fl <br /> 1 HEREBY CERTIPY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE EAWN,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS , <br /> CURRENT AND ACTIVE WITH THE CALIPORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL G <br /> WORKERS COMPENSATION LAWS <br /> ]MUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGN eD TITLE CEO DATE 07/18/06 _ <br /> N <br /> r <br /> t' C <br /> H IIJ 1 1 4M -7 A I <br /> N t• H M N <br /> DEP RTMENT USE PNYV ))�' <br /> Apptiudon Accepted By Data ` O A Me EmployalD _� / <br /> Gaul Inapadoo By Datc 0 SPECIAL Well Permit <br /> Pump lnspe,I.. I Data Zll<&R 17 WAIVER Received <br /> Datoa,ion Inspection By Date CoaNrueled Well Berth It <br /> COMMENTS S/Jw. �Sia'[ 'GIGS P!�` J/iftt� -{YIrLL`Z f31�1./Z'ffJ'i.✓_< ii�'!E= <br /> PE SC I Recalled ChahN/ ArWM q1e Permitl InvakeN 532 <br /> Well tag <br /> Cada leto Gsh Remitted SeMce ueHM <br /> o' 3 <br /> — 0 <br /> EHDIM-0 WELLNMFPERI <br /> cH.M <br />