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061126/2019 13:50 Canepa & Sons (FAX, P.002,,"004 t WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 NON-REFUNDABLE PERMIT CALL 20 953-7697 FOR INSPECTION$ EXPIRES 1 YEAR FROM DATE ISSUED LA Joe ADDRESS � OITYIZIPknw Ili CROSS STREET (/�• APN 2,ras-o&,- )C /'PARCEL SIz b LAND USS PPPUCATION# OWNER NAME ` /P]HOO.N��.7) A— QWNERADDRES8 }� t/44''�`? CITYISTATE/LP W)ft -3.�: V k I CONTRACTOR C.4NEPA AND SONS.INC. PHONE (209)532.1136 CONTRACTOR A111E58 14384 CUESTA COURT CRY/STATEJZJP SONORA,CA 95370 SUBCONTRACTOR PHONE SUBCONTRACTOR ADORE$$ mYY/6TAYE/ZIP LJcENsE IXC-57 ❑C$1 ❑0.09 ❑Othef NUMBER 425749 EXPIRATION DATE 7/31/2020 DOMESTIC WELL SAMPLING'❑General Minerat(Coliform Bacterid(4391)0 CIO ramochioropropane(4392)❑Arsenic(4393) rjq,I®�� INTENDED USE ❑Domestic/PrIvate D Irrigation/Agricultural ndwlfiol IC Weter Quality Monitoring ❑Soil 9amplinglCharacicrization ❑Pubr System �T /�/� It dlMeori ftront Gem Owner: Water tiyo;om Nomo Contact Name or Phone NUr,+ber //,, v TYPE OF WORK n New Well D Replacement Well 11Well Aheratlon/Modif cation :I Other VC 0 Monitoring Well(s) it of wells ❑Soil Boring(s) 0 of bodnpo O Geotechnical a er ocnnpo SqN O �oqn 0 Out-Of-Servlce Well D Out-Of�Service Well Renewal ❑Cross-Connectlon Repair FN gQV�N iJ New Pum ❑Pum RBplacement 11 Pump Repair :1 Raise Well Csain �h'ON COON WELL CONBTRUCTON OSpq F/yTgt �?' Drilling Method 0 Mud Rotary ❑Air Rotary ❑Auger ❑Cable Tool Ci Push Point ❑ Other RTiyENT Proposed Well Depth ft Excavation In diameter D Open Bottom ❑Gravel Pack/Gravel Sizc in diameter D Conductor Casing in dlameter / Conductor Casing Depth h Wolf Casing Dlomstcr_In Thickness/Gauge/ASTM Sched ❑Steel ❑PleBlle o Stainless Steel ❑Other Grout Seel Depth h ❑Neat Cement(94 Ib bag/6-10 gal watel 0 Sand Cement sack mW7 gel water ❑Bentonite(20%solids) ❑Other Grout Placement Method ❑Pumped ❑Free Fall D Other ❑Retsfdsnt/Accelerator name 11PQ:YPL n talled By ❑Driller Pump Contractor, 'I' Olhcr Concrete Pedestal OD; a slon&VRdlh E Length -i—ftTrIlck—Ill ❑Christy Sex O Stove PIPc punto XSubmersibleOTwrbine 0 Olhef HP___Zo Pump Set R Standing Water Level h I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERSCO PENSATION LAWS- UM 48 HO DVANCE NOTICE REQUIRED FO IMS � iY G/ E CALL(208)8 3- 97 Stcrono TITLa DnTE - � iV. a Ae � . C �y I Z -- P E N T U E .0 NNwL)Y C/ Apptlra'an Accepted By ate �/ ?'� � 1 Area EmPloyoa IDA Grout Inapealon B Date f� SPECIAL Wall Psrrnit Pump Inspection By ate I D 1 I "7�lel Q WAIVER Recolved Soil Boring Inspection By Dste Constructed Well Depth COMMENTS PE 9C Received Check*1 Amount Date Pcrmif/ Invoices Well II?p Codes Into 8 Csch Remitted Service Re uest# � — I Received Tlme—Jr.oaun. 26. -2019 1 :46PM-No, 5207 it-Received eiw, roacao ro�viu 4Z9-]s774WELL rPUMP PERMn