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•..WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 <br /> r <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED s �' <br /> JOB ADDRESS 5630L WOODBRIDGE ROAD W/0 21129 <br /> PARCELSEZE/ LODI 85240 <br /> SIMDES DAIRY 5630 WOODBUDGE ROAD PA <br /> OWNER NAME �_ ADDRESS <br /> crry/zlp LODI 95240 PHONE 369-2491 <br /> CONTRACTOR <br /> NOACK ADDRESS 4500 E. FREMONT STREETCOO <br /> AU <br /> STOCKTON 95215 948-8817 SAI•►JOA <br /> CQUiNS RVICES <br /> ITYPHONE N <br /> �pITAL HfjkLlit <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSH F RANGE SECTION <br /> TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: U WELL SYSTEM REPAIR ❑CROSS-cONNECC REPA;K ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW 11 REPAIR H.P. 1 z DEPTH P[7IIP SET 52 FI'_ FIRST WATER LEVEL 9' <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL N ❑SOIL BORING ❑DESTRUCTION: <br /> INTENDED USE TVPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA <br /> 15 DOMESTIC PRIVATE ❑GRAVEL PAC"IZE WELL CASING TYPE WELL CASING DIA <br /> ❑PUBLICIMUNICIPAL ❑DRIVEN GROUTSEAL DEPTH SPECIFICATION <br /> ❑IRRIGATION/AG 24 H R N OTt C E OTHER GROUT BRAND NAME <br /> ❑MONITORING R u-Q U E S E L] GROUT SEAL PUMPED: ❑YES ❑NO <br /> FO f: .A L_ - <br /> ❑cHR1STY BOX ❑STOVE PIptN S P E CT f C-'N CONCRETE PEDESTAL BY DRII_i_ER: ❑YES ❑NO <br /> APPROXIMATE WELL DEPTH` 78 <br /> PROPOSED CONSTRUCIIONWRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT TIM WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: <br /> Trr1.E: RETAIL SALES DATE:— JULY 11 2000 <br />