Laserfiche WebLink
�- <br /> WELL/PUMP PERMIT <br /> SAN Jorcum Couir,ENMRONMEWAL HEALTH DEPT 1988 East Harellon Aven us-STOCKTDN CA 9620541232 -(209)4884420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe AboRtee 2650 Stork Road CmZP Port of Stockton 95202 <br /> csonsmnar Wast Washington APN 145-03-01 PARCELSBE_LAND UDE Appu"Yfoi0 <br /> OWNER NAME Tesoro Compenles Inc. PHoNE 210.283-2000 <br /> OWNU MMOS 3450 South 344th Way CITYISIATEJLF Aubum,WA 980015931 <br /> cowTPwcroK Stents:Service lna PHOMa 878.881-0400 <br /> CoxmAcmR Abpxn 3017 Kilgore Road,Suite 100 cm/STATE/2M Renew Cordova,CA 85570 <br /> SUeoo MOR WDC Exploration and Wells pHOME 530$82.2828 <br /> SVscoNmAcroK ADDRESS 9580 Co Rd 8313 Cm13TAtt2M Zamora,CA 95698 <br /> UCENsE 7 J C-61 7 0410 3 Odnr Nustan 283328 EEPIRABDN DATE 8/10/12 <br /> GEOGRAPMCALINFORMATION: CoordIwMgX Y TownaMp_ Range_ Section_ <br /> INTENren UaE C DamesBWdyels C IRlgegaNAgdculturel O industrial 7 Water Dually,Monitoring 0 Sail Sempling/Chemclerize9on <br /> Public Water System <br /> nsmL,n n.In o..,.r. r <br /> TYPE OF WOR x r New Well n Replacement Wag n Well AllerabonlMod9kalbn XOther Destruction Of well OW-1A <br /> IXMonllodng Wall,) I aofwags So9Bodng(s) aanlre. IGeolechrucal aabod,MF <br /> I Out-OfServia Weil I I Out-0FSeMa Well Renews) i I Cmsa-ComaC9on Repair <br /> C Naw Purst n Pump Replacemera 0 Pun Repair C Raise Well Csslnq <br /> WELLCONSmgDTIDN <br /> Drilling Malhod C Mud Rotary U Ar Rotary M Auger 0 Cebb Tool It Puan Point ❑ Ogren <br /> Proposed Wall Deph R Exaveuon In diameter O Open Bottom C Gravel PeWGmvel Size In dlamster <br /> I Conductor Casing_N diameter / Conductor CoWng Depth R <br /> Wall Csshg Dlame w 7 In Thkkness/Geuge/ASTM Schad 40 3 Steel 0 Plastic 0 SMlnlew Steel I Other PVC <br /> Grout Seal Depth8 U Neat Car l(94 lb baprSl O pat Meier) U Send Cement deck mW7 gel water <br /> C Benlonlle(20%solids) -1 Other <br /> Gnat Placement Method O Pumped ]Free Fall ❑Other URetardant/Accelerator(name <br /> P@ftill Installed By 0 Dollar 0 Pune Contractor C Other <br /> I Conerato Podub)DlmenelonC Wldth_R Lmpin RTNQh Il Chdsty Box I Stave Pips <br /> F C SubmersibleC Turbine 0 Other HP Pump Se R Standing Water Leuel If <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 18 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN CO LIvgdN�CSE('W�I-'T�H/�LL <br /> WORKERS COMPENSATION LAWS. <br /> MINI OU VA NONCE gEOyl Rr�DFORI SPEC/T��+O��..,N-Gy� <br /> Sim y h•�¢:l G" O r�l(V'l ATE <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Deb Ata EmpbyeelDS <br /> Groin InsPMIW By Dale SPECIAL WeII PBrlfilt <br /> Pump Inspection By Date WAIVER Received <br /> Soil Saft Inspection By Dale Constructed Well Depth R <br /> COMMENTS <br /> PE SC ReeetVW cww Amount Date ParmiV hvOlcea Well IDs <br /> cool. Info cash Rmallted Servlee Ra uaata <br /> EM 4. WELL PUMP PERMIT <br /> M1414 <br />