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t INELUPUMP PERMIT SAN JOAQUIN COUNTY EN'MONMENTALHEALTH DEPARRiSNT 1865 EAsTHAM-MN AvENuE-STactcmN CA 95205-120)468-3420 INION-REFUNDABLE P4WiMfT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 4 YEAR FROM DATE ISSUED (JOB ADDRESS FloodZ!UcrympLinden CA 95236 CR=STREr/V. ESCaW &40'4Pr,C I APN 7 0 51 6 0 3 7 PARCELSUi DUsr APPLrxnctm; S G.B. Ranches OWNER NAME77ll PHONE in SOw,4eRADDRESS PO Box 673 CnV1SrATdZP Linden, CA 95236 COMRACTOR Purviance Drillers, inc PHONE 209-887-3554 CO:JTRAcMR AOORESS PO Box 64 CiY,STAfzL i n d e n , CA 95236 ISuecON Ri ACTOR PHOn- SUBrOMMACTOR ADDRESS Crryl$rpTE/ZtP ucelse R C-57 u C-61 :1 D-119 a Other NumBER 3 7 7 9 2 3 EXPIRATION DATE 7/31 /21 __ Da mGs i r Mf2LSA—,,PujG:C Genera(Mineral/CoCdortn Bacteria(4391)c Dmramachlomprapane(4392) Arsenic(4393) j INTSMED USE D❑amestirJPrivale InigationlAgncultural G Industrial G Water Quarity Monitoring D Soil Sampfmg/Characterization i i O Public Water System tfd�IIerentf,amowner. tVverSySL=mNam ComaGNan--vrPrior=-Number T YPE OF WORK X New Well C Replacement Well C Well AlteralianRAodification 0 Other :z Monitoring Wells) ofvrel6 CSot?BDring(s) T0rt"m4Es CGeotechnical Darrcrigs G Out-CF-Service Well G Out-OFSendce We0Reneral 0 Crass-CormeclonRepair G New Pump C Pump Replacement %Pump Repair 0 Ralse Well Casin �p b1f-C014STRUC77ON �DrilfingMethod pl Mud Rotary r A-uRetzry 0 Auger 7 Cable Tool 7 Push Paint D Other (Proposed Welt Depth—55-D ft Excavation m diameter it Open Bottom C Gravel PacWGrave)Sae in d- G Conductor Casing in diameter I Conductor Casng Depth S o z Zo19 Well Casing Di2me 1/2A(in Tnidmess/Gauge/ASTM Sched .'25Z NSleel 0 Plastic C StainfessSteel ]Other AIV.l� C-..tSeal Deptt(t) /Q�ft O NeatCernent(94Ittbad�YOgatvrateo V Send Cement/U.3 yds, Q(1(/V C C Sentonite(20IS sorids) �Other FP E V I T1' GroutPlacementMethod 9 Pumped D Free Fall 0 Other 0 RelardantlAcceleratar(nerne) ARTMCIV.• IEmesrAL Installed 6y 1#Dniter 7 Pump Conllactar D Other 1 e Concrete Pedestal CDlmensfonsr-Wdlh P. Length ft Thick in -i Christy Boz 0 Stove Pipe Pu61P D SubmermbleD Turbine D Other HP Pump Set fl Standing Water Level ft J I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THATTS WILL THE WORK SE GONE IN ACCORDANCE WITH SAN `I .IOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS- I ALSO CERTIFY THAT MY REQUIRED LICENSE IS i CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL NORISERS COMPENSATION LA MINI M 24 OII DV CE NQTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNS Tr-,Corporate SecretarffA,, ( III I II 11 I 111 I I I I II ! II II III I I I Ilill I ( III V III ( III II I I ( III Illi I I II IIl I ► I I ! III II ! ! Ill ll� I I I I Iltl I I 1111 Ill II ( III II II I I ! 111111 I. I ! 111 I I I I ! I I I I I l l ! I ( I I I I ii ( III IIII I I I I y I { I I III 1.I Illi I IIII ' I I I I I I I I I I I I II I I II JA I IIII ( I N I I II I I I I I I I I i I 1 1 1 1 1 I 1 1 11.1111 1 1 I 1 1 1 1 I. 1 Il I I I I �WIII ( III ill 1 ! 11111 , Il I ( IIII I II III l II ! ( I III ! it I IIII II II I I I I I I I I I I I III I I II I I I I II I li --V-6PA R TM ENT UIE 9NLY C ✓ � r Applir2Sian Accepted By Date /7 Area Employee 1D9 Grout Inspection By Date C/[ D+ SPECIhL Well Permit Pump Inspection By Date D #lJArVER Received Soil Haring Inspection By q'te0"W" nstructed Well Depth r t R COMMENTS Gi-O Se6- SC lit T D /Y/ PE SC I Received I Amount DatE Permit/ Codes _ Info. __ _ h _..._Remitted .( I Service.Re uest' InvoiceT we1u i I I I I - I ! I I U01 4-.'14 i:.l'in5 :•r ru::�a nr