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Wd l l :ti 8l0 '6l 'A'N- 9"61: aha <br /> u <br /> VVELUPUMP PE"IT casszos- zng aasaazo` <br /> SAN JOAQUIN COUNTY ENVI.ZO NIINTAL HEALTH DEPAR RAENST 1863 EAST HA�TONAVf7NE-STOOCM { ) <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 9 YEAR FRCM DATE ISSUED <br /> Jcis AcDRESS V' cm1aP_ <br /> D <br /> CROSSSTREEr Ls 9 r - APN SQ:E I-AmUSE APPLIGATwm- \ 1 <br /> 047NECNRWE PHOKE�oI`r <br /> Oww-RAODRE`S Q'v/S7prdDP 1 _ L <br /> CO:r;z,,Taa Purviance nrIllerS , Inc PHONE 2n —8Fi7 554 ` <br /> CO.'TrRA CTOR An DRESS PO Bog 64 C.rry/ L±n d e n , C A 9 5 2 3 fi l <br /> 5 J�CDNTRACTOFL FHDr-- <br /> S IJB[OfrTRACTOR AD➢FESS CYry/STATJL'P <br /> i UMDISE v C C-67 D 61 .71D-CO a Otho- NUMBER3 7%9 2 3 Expi ncn DATe 7/31 /19 <br /> ❑om STta IId:-�LLSAMPLLNG:o Ce petal%n2raUCeHfcrrn Bacteria(4391)=CFO ra,,nocNoro propan a(4392) Arsenic(4393) <br /> ruTEVOEDUSE !DomestaRrivale C:IrrigationfAgricultaral C;ndustnai CWater OuaEtyhloni;orirtg ❑Sol;SamplinelCharadetizaiion <br /> 0 Pu6Gc'AeleT S),! m. <br /> i IfCETere Cham chvntr N:IerSystm N.re C Vza Nary_a-Ptin=N.MD <br /> TYPg OFWoaK 0 Neev WP9 C Replacement WED C We?PoIemia.VMutTicalion D Other <br /> n PAD1titOfirtg W�l(s) oaf wells SDil Borings) ul MIUMS C GenieM%Cw_ -urbainas <br /> C Out-CfSenice Well C Out-OfServxe Well Renewal O CrasS Cannec+lorti Repair <br /> III Najq Pump C PanV Re cement (7-Pump Raoair 7 Rase'LVeY Castn <br /> wEti cmrsTaucnaN <br /> 1t7r1l ting Meth a d 0 Mod Rotary r_A`r Rawly �Aoger D Cagle Tool 7 Push Point 0II <br /> r Proppsed VJEII Qglh R Excavation in diameter _open Bottom G Gael Pack/Grava:Size an eter <br /> Q ConduUDr .sn',g in dame[er f CwWurlw Casing Depth fl <br /> Lyell Ling Diameter_in Th dolesslGaugeIAS M Srhed =Sleet 7 P1asEc ?Stainless Steel ]Other <br /> Grout Seal Depth >v 7 Neat Cement(94 m bacJ 10 gal grater) 7 Send Cement Sad,--usl7 gal Crater <br /> C.Bentonite(20%Solids) D 011ier <br /> IGrout Placement Method r.Pumped DFree Fall -.A Other �RetardantlAttEleratcr(rrame) ____ ___ _ <br /> fPm25TAt lnstafled 6y Q Dreher 7 Prang Ccntadcr D Other <br /> C Concrete Pedestal CDlmenslonss:Irf-elh rt I-Pitglh h Thick in -1 Christy Box J Sieve PI pe <br /> IPump b SLbmersibleD Turbine 7 Olftr HP Pump Set It Standing Water Level f; <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK Lti9LL HE DONE IN ACCORDANCE wrni SAN <br /> JOAQUIN COUNTY ORDINANCES, STAT'. LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED 110EUL E IS <br /> CURRENT AND ACTIVE VIITH THE CALIFORNIA C017TRACTORS STATE LICENSE BOARD AND THAT I AM IN CMIPL1ANCc WITY. ALL <br /> WO 7-ENSA, <br /> PJIINI iYli'1 U VAAiCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> s Tzorrorate Secretary <br /> 1 I i <br /> I I I I II <br /> I ' I I EIII <br /> I I <br /> I I I <br /> I I I <br /> I I i I I I I <br /> i I li I <br /> I <br /> i II I <br /> Tt1ENT U E N Y A ,cL� <br /> AppEratisn Accepted By to Area [ Employee ID'i W� -/ <br /> Omni Inspection By Date 7 SPECIAL WeiI Permit <br /> Pump Inspection By <br /> T• 1 Date___> 17 1JVAnVER Received <br /> Sal Boring lnsrectlun By Dale CansiTuctedWell Depth ft <br /> COMMENTS <br /> PE SC Received CheckX Amount Oa,e PerrMU InvolceT WellIDY <br /> Co s_. .Into. _ _13Y__- -- �h _ _RDmtned ei—Rawu-es[ <br /> ylqiq <br /> 9 <br /> I I <br /> I i <br /> l'.S rN'=PPLL� <br /> Ef?J<7-1 F1-'ff6 <br /> Z'd out SA811!-I(]aouelA.md d68:t'0 8L 6L AON <br />