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7r;1'w� gi��g10-1611yP^ a� tb <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HA LTON AVENUE-STOCKTON CA 95205-(209)4$8-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Job ADDRESS <br /> CROSS STREET IIN/�NRTL &.I/; W —APN Z� PARCEL SIZE�LANDUSEAPPLICATIONC <br /> ✓ <br /> OWNERNAME �VVJPHONE <br /> OWNER ADDRESS L3 (,L),J.AALA4 � CTYI$AZ ( M <br /> CONTRACTOR Kleinfelder PHONE 209-948-1345 <br /> coNTRAcToRAooREMS 2001 Arch-Airport Rd. Suite 100 CITYISTATEGS,Stockton, Ca. 95206 <br /> SUBCONTRACTOR V&W Drilling PHONE 209-469-7700 <br /> SueCONTRACTORADDREss 3806 Duck Creek Dr. CITY/STATEIZIP Stockton, Ca. 95215 <br /> LICENSE XC-67 iI C-61 I D-09 I Other NUMBER 720904 EXPIRATION DATE4/3 O1Q <br /> GEODRAPMCALINFCRMATION: CWrdl.M"X Y Townshlp_ Range_ Settlor_ <br /> INTENQEDUSE t DomesticlPdvaW IMgatioNAgdcWlural Industrial I.Water Quality Monitoring (Soil Sampfing/Characterization <br /> PWlaen ahmnrOwsirerem .e, nemon emaM U <br /> TPEOr WORK I New Well ReplacemenlWH1 Well AlleratioNModificatlon Other <br /> I Monitoring Wells) IIof Wells Son Bodng(s) FMbanres 'AGeotechrical�sarevNgr <br /> I OW-0I-Service Well Out-OfSenrw Well Renewal Cross-Connecgon Repair <br /> L New Pum2 Pump Replaxemsm Pump Repair J Raise Well Casin <br /> WELL CONSTRUcaON <br /> Drilling Method)(Mud ROWry Air Rotary Auger Cable Tool Push Point Ii Other <br /> Proposed Well Depth 1;-7 f) It Excavation G in diameter Open Bottom I Gravel Pack/Gravel Size In diameter <br /> Conducor Casing in diameter I Conductor Casing Depth It <br /> Well Casing Diameter_in Thickne�s/s/Gauge/ASTM Sched Sleet I Plastic Stainless Steel Other <br /> Grout Seal Depth 70 ft Neat Cemem(941b ba9gy&10981Wafed Sand Cement satRmod7gilmter <br /> Bentonite(20%Solids) <br /> Grout Placement Method Pumped IFree Fall ')$Other _'Retardant I Accelerator(name) <br /> E9119m]. Installed By Driller I Pump Commalor - Omer <br /> Concrete Pedestal'.101menslomr Width ft Length ft Thkk in L.Christy Box Stove Pipe <br /> MP i Submersibles Turbine ]Othtt HP Pump Set ft Standim Water Level It <br /> 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. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MININ)UM 4 HO /R% ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIDNED� /.� lLe� TITLE 112;`e- DATE /J / <br /> 1 <br /> T� <br /> - <br /> � DEPARTMENTU/ EJ <br /> �T IN/LY �� <br /> Application Accepted By e.. Data T/ 4V lllL Area Employee lDk-St��Q((k5 <br /> Grout Inspection By Date C SPECIAL Well Per#PAyM"E�N�T- <br /> Pump Inspection By Date C WAIVER Receive'RECEIVED <br /> Soil BodnglnspecbonB I Date Constructod Well Depth ft <br /> COMM NTS <br /> 5 &t wigil <br /> 'PE SC Received Ch.kW Amount Data Ps IV Invalce PEAL HOE <br /> Codes Into B Cash RamHtad Service uastB <br /> 3 (,6 5 9 ID f il sIZ00-761 4 <br /> rpys 2- <br /> HELL HUMP PEmI'.T <br /> EHD41re <br /> ary#If <br />