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#9904 WELL/PUMP PERMIT <br /> SAN JOAQUIv COUNTY ENVIRONMENTAL I I DEPARTMENT 600 E.Main Street-" 'CION CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS L AES 1 YEAR FROM DATE ISSUED <br /> rn <br /> JOBADDRESS• - 7000 W. Windmill Cove Road CITYIZtP Stockton. 95206 <br /> CROSS STREET Holt APN 131-220-09 PARCELSIZE (q-0 LAND USE APPLICATION II - <br /> OWNER NAME Inga Dement Machado - PHONE 462-2764 1 <br /> OWNERADDRESS same Cm/STATFIZar i <br /> i <br /> CONTRACTOR. _Delta Pump PHONE 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATEPLrP Stockton. CA 95203 <br /> SUBCONTRACTOR PHONE <br /> j <br /> SU13CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE [I C-57 XXC-61 [3 D-09 ❑Other NUMBER 724778 ExPIRATIONDATE 8 .10 <br /> GEOGRAPIICALINFORMATION: Coordinates X Y. Township Range Section_ <br /> i <br /> �INTENDFDUSE M)om_estic/Private ❑laigation/Agricultural ❑Industrial O Water Quality Monitoring ❑Soil Sampling/Characteruation <br /> ❑Public Water System <br /> If ailierent f..Owner W.I.sym. _ oatact sac or r <br /> TYPEOFWORK ❑New Well ❑Replacement Well ❑Well Alteration/Modification ❑Other <br /> ❑Monitoring Well(s) g ofwells ❑Soil Boring(s) sotbrariagr ❑Geotechnical sot boriagt <br /> ❑Out-Of--Smite Well ❑Out-Of-Scrvice Well Renewal ❑Cross-Connection Repair i <br /> i ❑New Pum '&Pump Replacement ❑Pump Repair C <br /> WEI.I.CpNSTRUCTION - <br /> O <br /> Drilling Method ❑Mud Rotary ❑Air Rotary ❑Auger ❑Cable Tool ❑Push Point ❑Other <br /> Proposed Well Depth ft Excavation in diameter ❑Open Bottom ❑Gravel Pack/Gravel Sae in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameterin Thickness/GaugeJASTM Sched []!Steel ❑Plastic ❑Stainless Steel ❑Other <br /> j Grout Scal Depth ft ❑Neat Cement(P4 1b bag/5-10 gal water) i. - ❑Sand Cement sack ma/7 gal water <br /> 1 ❑Bentonite(20%solids) ❑Manufacturer Spec%solids_% Name ❑Specs on File ❑Specs Submitted 1111 <br /> it Groot Placement Method El Pumped ❑Fra Fal! [I Other ❑Retardant 1 Accelerator(name) �.) <br /> � Z <br /> PEDESTAI. Installed By ❑Driller ❑Pump Contractor ❑ Other <br /> ❑Concrete Pedestal Dimensions:Width ft Length R Thick in ❑Christy Box ❑Stove Pipe <br /> I Em W Submersible ❑Turbine ❑Other HP ' Pump Set 33 z ft Standing Water Level 12 it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE W ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS n <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL e, <br /> t�..�WORKERS COMPENSATION LAWS. <br /> y~ UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS y <br /> SIGNED TITLE CEO DATE 08/25I0$ <br /> IV <br /> d <br /> 3I I IWCAL- <br /> IL <br /> l <br /> 1 <br /> i <br /> I <br /> ;I <br /> f <br /> I <br /> ► - -- <br /> :y----U-EPA MENT 'SE ONLY <br /> le Area. <br /> r��-W'Gilroutlnspccli <br /> n!ibn:Acceptei By-'�- - '..Date !. —r..•Area�-- .�_ . mploys lDN,on By Date ❑ SPECIAL Well Permit <br /> 7 <br /> Pump 1Ppection B ..r - [' i" Date ZS5-� ❑ WAIVER Received <br /> Constructed Well Depth R <br /> COMMENTS <br /> 1,444 66 4 <br /> PE SC Received 6Chu Amount Date Permit/ Invoice N Well IDN <br /> Codes [oro B Cash Remitted Service Re uest# <br /> �O0 SS 3 0 1uPOt7�2 SZ) <br />