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WELL/PUMP PERMIT <br /> � 9-3420 <br /> �REFUNDABLE PERMIT E1CPn1ES 1 YEBLIC HEALTH SERVICES�AB FROMF�DATE ISSAL WELL <br /> DIVISION , `p►� <br /> JOB ADDRESS 22871 Mariposa Rd Escalon 1><EL� / PVIVIF� <br /> PARCELSUXJAPN CfIY21P Escalon, Ca <br /> OWNER NAM Price ADDREss 21657 E. Dodds Rd. <br /> cmrz>PEscalon CA 95320 rxoNE <br /> coNTRAcroRPurviance Drillers P.O.Box 64,Linden,CA 95236 <br /> CITYIZIP Linden PHONE 209-887-3554 <br /> GEOGRAPHICAL INFORMATION:COORDINATES X_ Y TOWNSMF_ RANGE_SECTION <br /> TYPE OF WELL: :@ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# _❑OTHER <br /> INSTALLATION: 0 WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL <br /> TYPE OF PUMP: 12 NEW ❑REPAIR H.P. 5 DEPTH PUMP SET j-47 FT. FIRST WATER LEVEL <br /> ❑OUT-OP-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION- <br /> INTENDED <br /> ESTRUC ION-IN'T'ENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL. XWPEN BOTTOM WELL EXCAVATION Bull I—V 4CONDUCTOR CASING DIA <br /> MESTICPRIVATE ❑GRAVEL PACK/SIZE_ WELL CASINGTYFE Steel WELL CASING DIAS 5 8 <br /> ❑PUBLICJMUNICIPAL ❑DRIVEN GROUTSEALDEPIH 280 SPECIFICATION .156 <br /> APRIGATION/AG OTHER GROUT BRAND NAMH <br /> ❑MONITORING GROUT SEAL PUMPED: 70 YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES ❑NO <br /> APPROXIMATE WELL DEPTH_325 <br /> — <br /> PROPOSED CONSTRUCTION/DRILLING METHOD:MUD ROTARY X AIR RCIARY AUGER-CABLE-OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> TTILE; Corporate Secretary DATE: 7/5/00 <br /> Ruas <br /> 1 FNIAL <br /> DEPARTMENT USE ONLY <br /> Application Accepted By �!7 Ihte J �Q�f AicaI <br /> Grout Inspection By Date!,nnT Inspected By Date <br /> DeslrvcUon Inspection By Date <br /> COMMENTS: <br /> FE SC AMOUNT CHECK RECEIVED DATE PERMIT/SERVICE REQUEST# WELL IDN <br /> CODES INFO REMSCTED BY <br /> J < <s z 3 <br />