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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6220 N Wall Rd CITY/ZIP Linden , CA 95236 m <br /> Walnut 09130001 Iq T <br /> CROSS STREET APN PARCEL SIZE AND USE APPLICATION# p <br /> [ In <br /> OWNER NAME Filers Ranch ,, LLC Julie Titers—ClaryPHONE <br /> OWNER ADDRESS PO ' BDX G9, N <br /> 7 6 MIL-11L4TY/STATyz P Linden , CA 95236 <br /> CONTRACTOR Purviance Drillers , Inc PHONE 209/--+887-3554 <br /> CONTRACTOR ADDRESS PO -Box 6 4 CITY/STATE/ZIPL i n d e n 1 C A 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATFJZJP <br /> LICENSE C-57 LI C-61 -1 D-09 i7 Other NUMBER 377923 EXPIRATION DATE 7/31 /19 <br /> DOMES FIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)-_ Dibromochloropropane(4392)-Arsenic(4393) <br /> INTENDED USE n DomesticlPfivale B Irrigation/Agricultural C Industrial C Water Quality Monitoring n Soil Sampling/Charactenzation <br /> Public Water System <br /> If oiRerent from Owner: Water System Name contact Name or Phone Number <br /> TYPE Or WORK C New Well )(Replacement Well G Well Alteration/Modification 7 Other <br /> f?Monitoring Well(s) #of wells C Soil Boring(s) a of honngs C Geotechnical #ofborings <br /> Out-Of-Service Well D Out-Of-Service Well Renewal _]Cross-Connection Repair <br /> New Pum G Pump Replacement E Pump Repair 7 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method WMud Rotary F Air Rotary ❑Auger J C Cable Tool -1 Push Point "? Other <br /> Proposed Well Depth�ft Excavation /9 I'll in diameter Open Bottom C Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing N/A' in diameter / Conductor Casing Depth ft <br /> Well Casing Diamele/ $ in Thickness/Gauge/ASTM Sched .2.0 )p Steel C Plastic L Stainless Steel _Other <br /> Grout Seal Depth t ft 7 Neat Cement(94 Ib bag(5-10 gal water) W Sand Cement sack rnwr7 gal water <br /> Bentonite(20%solids) J Other <br /> Grout Placement Method X Pumped ❑Free Fall D Other _Retardant/Accelerator(name) <br /> PEDESTAL Installed By )(Driller 7 Pump Contractor ❑ Other <br /> C Concrete Pedestal CDimensions:Width ft Length ft Thick in _i Christy Box -i Stove Plpe <br /> PUMP ❑Submersibleu Turbine 7 Other HP Pump Set ft Standing Water Level It <br /> I HEREBY CERTIFY THAT I 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 /> WORKER PENSATION <br /> MINIM 24 A A��N��CE�NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED -P TITL. o r p or ate S e c r e t a r DATE 9/7/ 18 <br /> I <br /> ��9y <br /> SF'°oF7t <br /> y '� ,,� <br /> O '�P�Nr�MY <br /> TM <br /> PC TMENT US O L <br /> Application Accepted By�VA ate Area Employee ID# <br /> Grout Inspection By Dale 1 PECIAL Well Permit <br /> Pump Inspection By Date ) WAIVER Received f—�O <br /> Soil Boring Inspection ey Date Constructe Well Depth ft <br /> COMMENTS Z—CX <br /> L a .,�• Sp"-_rte L r,�^ <br /> PE SC R ed Check#/ Amount D Permit] Invoice# WeIIID# <br /> Coles to Cash Reied Service Reuet# <br /> END 43-06 6101/76 0 tC � PV rm [. �'I--o,aC: " ELL/PUMP PERMIT <br />