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WELL/PUMP PERMIT <br /> iSAN JOAQUIN COUNTY ENVIRONMENTAL 1- 1 DEPARTMENT 304 E WEBER AVE STOCKTON CA 95202 -(709)468-342, <br /> NON-REFUNDABLE PERMIT -- CALL(209)953-71197 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> ---- rn <br /> JOB ADDRESS 18775 TOM PAINE AVE, clr tztP TRACY,CA 95304 > <br /> CRO55STREET CANAL BLVD. APN 213-020-30 PARCELSLZE , _LANOUSE APPLICATION 9 <br /> O"ERNAkIE ERNIE COSTAMAGNA PHONE 559-269-203 <br /> OWNEltADDRESS P.O. BOX 817 CMVSTATEIZIP SAN.JOA IIIN CA 93 0 <br /> c,,,,Ac,, HENNINGS EROS. DRILLING CO., INC. PRo,x 545.1185 <br /> Ei <br /> i CONTRACTORADDREM 3525 PR ANDAI F AVF_ — C1TY1sTATFizip MQj]F;TfI___rA 4r,3ri5 <br /> SUBCONTRACTOR PHQNQ <br /> SuBCONTRACTORADDREss- CITVISrATFJZIP <br /> .� LICENSE EIC-57 Q C-61 ❑D-09 Q Other NUMBER 29Q813 EXPIRATION DA's 5-31—QS <br /> GEOGRAPHICALINFORMATION., Coordinates X v Township Range Section <br /> IMYNDED 11n ) Domestic/Private ❑Irri non/, cultural Q Industrial 13 Water <br /> ga' gri Quality Monitoring 0 Sail Sampling/ChaeaeterizsdoR <br /> ❑Public Water System <br /> If .diffr..1 from pane: ala y"em Nam mW'Nam w Phww NurnWr <br /> TYPEOP WORK dNew Well ❑Replacement Well 0 Well Alteration/Modification ❑Other <br /> ❑Monitoring Wells) A of wells Q Soil 6oring(s) softaringr Q Gewechnieal M'of borings <br /> l Q Out-Of-Service Well ❑Out-Of-Service W e,11 Renewal ❑Cross-Connecs;on Repair <br /> 1 l Cl Now Pump d Pump Re lscement Q Nmp Repair <br /> l WELL CONSTItUMON <br /> 4 ck Dr111lag Melhod ElMud Rotary Q Air Rotary Q Auger ❑Gbit Tool ❑Push Point 0 Other <br /> Proposed well Depth 200 ft Excavation 12" in diameter ❑Open Bottom IXGravel Pack!Gravel Size in diameter <br /> Cl Conductor Casing indiameter / ConductorCasiagDepth ft <br /> i Well Casing Diameter 6 in Thickness/GaugeIASTM Schad 160CL ❑Steel 16 Plastic Q Stainless Steel ❑Other <br /> Groin Seal XX <br /> 100 ft 13 Neat Cement t.04 lb bag/5-10 gal water) ❑Sand Cement s=k mfx 17 gal water ' <br /> XX Bemorsitc(2014.solids) Q Manufacturer Spec%solids % Name ❑Spccs on l`Ac ❑Spcca Submitted <br /> Grout Placement Method X%Pumped ❑Free Fall U Other_ ❑Retardant/Accelerator(name) <br /> 'F YkDEsfAL' Installed By Q Driller M Pump Contractor ❑ Other <br /> ❑Concrete Pedestal Dimepatpns:Width ft Lcrtgth R Thick in ❑Christy Box [IS Pipe <br /> i' PUMP ❑Submersible Q Turbine_❑Other _ HP.--Pump Set ft Standing Water Level ft <br /> i 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_ 1 ALSO CERTIFY THAT MY REQUIRED LICENSE 19 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL . <br /> MINIMUM 24 HOUR ADVANCE N9,TI.CE REQUIRED FOR INSPECTIONS <br /> i <br /> SIGNED i"" •�1'r1Le SUPERVISOR DATE 12-27-07 <br /> ' <br /> €t <br /> L' G, Flu L <br /> VP y _ <br /> 51 1 a - 46 to < <br /> / 1, <br /> 1.I <br /> F r< - <br /> -C, s fr x O N <br /> n !i <br /> L /G'e <br /> - 1 _1 <br /> 5 u -- <br /> FM I 0 <br /> or C TIC <br /> E ARTMENT USE ONLY <br /> 1 Application Accepted Date At" Emplrpee IDA <br /> t j Grout inspatiar, y/- � 7 � - Date 0 SPECIAL Well Perllcit <br /> P Fumy inspection By Date 0 WAIVER Received <br /> 1 ' <br /> ' i <br /> Constructed Well Depth ft <br /> COMMENTS. <br /> PE SC Received Ghee Amount Date lnvplet A We111D,b <br /> Codes info H Cash misted Service R nest <br /> 1 0 3zS` a SRoo 5 3b z lu OD 2 d'$9 <br /> i <br /> i ' <br /> Elio 43.0.aoe <br /> 1 lmnaos ABLE Pl1MP PERMIT <br /> I � , <br />