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1 841 0 <br />17:0A,A (i.ckr% Or"Or <br />WELL/PuMP PERMIT <br />ri JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue -S-rockroN CA 95205-6232 - (309) 468-3420 <br />)N-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />El ADDRESS 7735 S T BT 9c) W FRONT RD. CITY/Zip STOCKTON 95206 <br />OSS STREET QANTAS TN APR 177-26-014 PARCEL SIZE304.4a, —ND USE APPLICATION # <br />VNER NAME MORADA PRODUCE CO. p H0NE 546-042-6 <br />',USER ADDRESS cnn N ,TArK 'TONE PD. crcrisTArEalp STKN CA 95215 <br /> <br />INTRACTOR Delta Pump -smorxmoN ARMATURE & MOTOR WORKS tritatik. 209-466-9625 <br />INTRACTOR ADDRESS 646 S. California Street CITYISTATE/ZIP Stockton, CA 95203 <br /> <br />BCONTRACTOR PHONE <br />°CONTRACTOR ADDRESS CITY/STATE/ZIP <br />:DISE DC-STNC-Si 00-09 0 Other NUMBER 724778 EXPIRATION DATE 08 /11 <br />:OGRAPHICAL INFORMATION: CoorclInateS X Township ' Range Section <br />'ENDED USE 0 Domestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring D Soil Sampling/Characterization <br />0 Public Water System If different from Owner: water System Name contact Name Or One NUMber <br />PE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br />it 0 Monitoring Well(s) of borings of wells 0 Soil Boring(s) 0 Geotechnical # of borings <br />0 Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br />0 New Pump 0 Pump Replacement X9eump Repair 0 Raise Well Casing <br />_ILL CONSTRUCTION <br />tiling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Other <br />°posed Well Depth ft Excavation In diameter 0 Open Bottom 0 Gravel Pack/Gravel Size in diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter In ThIckness/Gauge/ASTM Sched 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br />Grout Seal Depth ft 0 Neat Cement (94 lb beg/5-10 gal water) 0 Sand Cement ' sack mlx17 gal water <br />0 Bentonite (20% solids) 0 Other <br />out Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant / Accelerator (name) <br />IDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />0 Concrete Pedestal Dimensions: Width It Length ft Thick in 0 Christy Box 0 Stove Pipe <br />iit 0 Submersible IkKurbine 0 Other HP A ft Pump Set 1 40 ft StandingAZAter Level 53 ft <br />:-IEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />MIQUIN COUNTY ORDINANCES, 'STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />ARENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />ORKERS COMPENSATION LAWS. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIP.ED FOR INSPECTIONS <br />ONED CEO <br />rr111111.1.II <br />TITLE Dfii 21 /2016 :ssaaaay 311S H 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 <br />REC <br />U <br />MED <br />23 2016 <br />FUNIPMELL Is 10..1 Inside Ole enclosure <br />nest to Quanta, In ed <br />Emottorxr-NTAL HEALTH -PC-Rktm SERVicEs <br />42-Nher -ce7y6 <br />23 281,.. <br />w Ro <br />IIHILIHHImIH <br />RTMENT USE NILY <br />Application Accepted By Date <br />Grout Inspection By Date <br />Pump Inspection By PAgkviV1 Art) QC/ Date /17/// <br />Area Lige/ Employee ID/Fr:Sae-0 <br />SPECIAL Well Permit <br />WAIVER Received <br />Soil Boring inspection By Date Constructed II Depth ft <br />ommENTs 100/6- 4.17711 eszolove6=M31 - e /4-T77o-- <br />PE <br />Codes <br />SC , <br />Info By <br />ReceivedC,lagAgit," <br />----Vieh <br />Amount <br />Remitted Date Permit/ <br />Service Request 8 Invoice 8 Well ID/-/ <br />p25:iLsp/ 6/A ,2_7678- 4,53,4v 017-37/10 Elz.0075-M 0003(0)2J-1 . <br />1 <br />J <br />1 1 1 1 1 <br />43-05 WELL/PUMP PERMIT