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( WELL/PUMP PERMIT <br /> 1(/�^ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAMILTON AVENUE-STOCKTON CA 95206-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED va <br /> ✓� O�q 1120 Frewert Road Lathrop,CA 95330 <br /> 6 D JOB ADDRESS CITY21P n <br /> S.Manthey Road 191-270-05 zo Acres D <br /> CROSS STREET APN PARCEL SIZE LAND USE APPLICATION# Cr <br /> 'r ONMER NAME Harvest Power <br /> PHONE <br /> OMER6943 N Golden State Blvd. CITYISTATERIP Fresno,CA 93722 <br /> CONTRACTOR <br /> ADDRESS <br /> �✓� JIJ / <br /> h / oxTRncroR Cal PaC Drilling PHONE 909-795-7500 <br /> _,/ 526 W.Ave.L Calimesa,CA 92320 <br /> 0 CONTRACTOR ADDRESS CITYSTArE21v <br /> SUBCONTRACTOR PHONE <br /> lity f9 SUBCONTRACTORADDRESS CITY/STATFRIP <br /> ✓Z <br /> / L'ICENSE Y.C-57 C-61 609 OIhBr NUMBER 766402 EXPIRATION DATE 07/31/2017 <br /> 4 � GEOGRAPHICAL INFORMATION: COOrdiDu..X Y Township_ Range_ Section— <br /> I INTENDED USE Domestic(Private Imgalien/Agricultural Industrial AWaEmQpWMonItorinq Soil Sampling/Characterization <br /> ` Public Water Systen Days Betedepura,PE,Ph l949)510-8874 <br /> Hdlaxentfran Orimer Cvolarr Name or one um <br /> i o <br /> I( ° TmE OF WORK XNew Well Replacement Well Well Nterdtion/Nbdificotion Other <br /> ),'Monitoring Welps) 2 of wells Shc Bodng(s) #°ibanrga Geotechnical sofbotl,' <br /> Out-Of-ServiceWell Out-Of-SerNce Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casino <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary I Air Rotary X Auger Cable Tod Push Point Other <br /> Proposed Well Deplh_c, l5 it Excavation 8" in diameter Open Boman XGravel Pack/Gravel She Sand in diameter <br /> -size <br /> Conductor Casing in diameter / Conductor Casing Depth IT <br /> Well Casing Diameter 2 in Thickness/Gauge/ASTM Schad 40 Steel XPlastic Stainless Steel Other <br /> Grout Seal Depth 10 it Neal Cementry4fb bs✓f0�galwaler Sand Cement sack mix/7 gal water <br /> XBenlonee(20%solids) Other ll <br /> Grcut Placement Method Pumped YFree Fall Other Retardant l Accelerator(name) <br /> PP UP�uI&LL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dlmenslons:Width_it Length ftThick m Christy Box Steve Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft StandinBWaler Level fl <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 /> WORKERS COMPENSATION LAWS. <br /> MINI UM 24 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIDxED Tme President,ABI Engineering Consultants,Inc.DATE 6/30/2016 <br /> -RECEIVED <br /> SEP 0 6 2016 <br /> ppYMrViRONMENTIALHEALTH <br /> RETEI ERMa-ISER"CES <br /> SEP <br /> sw JOA <br /> E" E <br /> MFALTM <br /> lit I ——— <br /> DEPARTMENT USE ONLY clef <br /> Application Accepted By O Date Area EmployeelW /07kYd <br /> Grout Inspection By Data 11 SPECIAL Well Permit <br /> Pump Inspection By Date 'I VIAIVERRmeived <br /> Soil Boring Inspection By Dale Constructed Well Depth R <br /> COMMENTS <br /> PE SO Raceivetl Check#/ Amount Date Pemw Invoice# WeIIID# <br /> Codes Into B Cash Remitted Service Re uest# <br /> Zyol 313 NT. /°9d -�78m 51C06 <br /> E1003M W LL6VMPPERMIT <br /> 4MW12 <br />