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WELL I PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE Y°FL-STOCKTON CA 95202 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> :n <br /> JOB ADDRESS 7595 14. DELTA AVE. CIT./zjpTRACY,CA 95304 <br /> CROSSSTREET 'I"a r� - APN 213-020-05 PARCELSIX✓`-�- LAND USE APPLICATION <br /> OWNER NAMEWILL & GLADYS HEINRICH PHONE 836-4505 <br /> OWNER ADDRESS 7595 W. DELTA AVE. crrv/STArezIPTRACY, CA 95304 <br /> CONTRACTOR HENNINGS BROS. DRILLING CO., INC. 4 PHONE 545-1185 <br /> CONTRACTORADDRESs HENNINGS BROS. DRILLING CO., INC. CITVIStiATEILIP MODESTO,CA 95356 <br /> SUBCONFRACTOR PHONE <br /> Sf-BCONTRACTOR ADDRESS CITY/STATFJZIP <br /> LICENSE 6k-57 ❑C-61 ❑D-09 I7 Other NUMBER 290813 ExPIRATiON DATE 5-31-08 <br /> GEOGRAPHICALINFORMATION: Coordinates % Y Township Rrnge Section <br /> I. NVTE DED USE E Dexnratic/Pinata 0 Irrigation/Agricultural ❑Industrial ❑Water Quality Monitoring ❑Soil Sampling/Characterization <br /> ❑Public Water System <br /> Ifdin—t from O.vner: W:trs.yuem eine —L., <br /> TYPE OF WORK 10 New Well ❑Replacement Well ❑Well Alteration/Modification O Other _ <br /> ❑Monitoring W'ell(&) N of wells ❑Soil Boring(s)_ _ s of bo"nr D Geotechnical s°fbwNp <br /> ❑Out-Of-Service Well ❑Out-Of-Scmiec Well Renewal ❑Cross-Connection Repair <br /> O New Pump ❑Pump Replacement ❑Pump Repair <br /> WELLCO_ STAUTTION <br /> Drilling Method X1 Mud Rotary 0 Air Rotary ❑Auger ❑Cable Tool 0 Push Point ❑Other <br /> Proposed Well Depth 20D ft Excavation_.14 a in diameter ❑Open Bottom lI Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth f1 <br /> Well Casing Diameter 8 in Thickness/Gauge/ASTM Schcd 160 ❑Steel Cf Plastic ❑Stainless Steel ❑Other p <br /> Grout Seal Depth 100 it ❑Neat Cement N41h hag/5-10 gat water) Ell Sand Cement sack mix 17 gal water In <br /> ){1 Bentonite(20%solids) ❑Manufacturer Spa:%solids_% Name_ ❑Specs on File ❑Specs Submitted _1 <br /> Grout Placement Method Irl Pumped ❑Free Fall ❑Other___ ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller IXPump Contractor 0 Other ' <br /> ❑Concrete Pedestal Dimensions:Width A Length—_fl Thick in O Chitty Boz Cl Stove Pipe fl <br /> PUMP ❑Submersible ❑Turbinc ❑Othcr IIP __ Pump Sc( R Standing Wucr Level fl <br /> 1 HEREBY CERTIFY THAT I RAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> ,yp rsN COUNIY aRDJNANCES.STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS A <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTR c-roIKS S1ATEZtCERSE-B6TRD-AND-TTA-T--XM IN-COMTLAANCLWITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> C <br /> MINIMUM 24 HOUR ADVANCE NQ"iICE REQUIRED FOR INSPECTIONS m <br /> SIGNER gE. — ITLE SUPERVISOR DATE 5-30-07 <br /> L 9 <br /> z <br /> - E <br /> 9 <br /> S I V ^ d <br /> �1 <br /> Aym <br /> AU 3 <br /> t <br /> J <br /> 4 <br /> S N O <br /> T D P TLi I <br /> DEPARTMENT U$E ONLY S <br /> Application Accepted Ry_ - _ Date .3D ItIIc 7 _ Area Employee[D# 4(-C <br /> Grout Inspection By. — - Date 1/ 1{0 1 ❑ SPECIAL Well Permit <br /> Pump)nspectloa By Pate ❑ WAIVER Received <br /> Constructed Well Depth it <br /> COMMENTS-0-0 407 C F P--..61e:3P--..61e:3 <br /> fac"C#Az�-- <br /> zto <br /> PE SC Received Check#/ Amount Date Invoice# Well III* <br /> Codec Into Remitted Service Re nest 8 <br /> EHD47-02.006 WELL PIr%V PERMIT <br /> 1.77,7005 <br />