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SAN IGAUUTA COUNTY PUBLIC HEALTH SERVICES f�/1ls <br /> 9'lY1RDNMFHTAI HEACiH DIYISIDN I '� <br /> a}AaI�Y 3TDC7RDA. Cd .°S23I1 <br /> ;} <br /> WdgtEZPFRFS D R FROM DATE ISSUES� /��i- \ �� <br /> AhAlicaNm is here SY _dam -he San JaaWxx <br /> in CcY for as prm <br /> eh w�tr`ut and/or inscalL the work is <br /> Qrcri Sed. This a lio:i°n <br /> wade in cmioliarae .1th San JOa Zin Canty O"-ia senc Ti tt Chapcer 9-1115.3 and Ne Starrards of San JoagJin Canty Pt:i(c Anith <br /> Services, E.•rvirormea+tal Health Division. (D�'��D� 1 <br /> 3 <br /> Jeb A6crass/or APNa 5400 T AV TFIC AVE=2 City Stockton Parcel Si e.IAPut ` <br /> (1Srer•s rax <br /> Montgomery..;lard leAres 5400 Pacific Avenue Phonez714/7736227 <br /> C=tr%tor" <br /> nvironmental Audit, 7Agr;= 1000A Ortega Way Lij 606348 Pherxt714/632-8521 <br /> SCS Contncor V & W Drilling Address Monier Park Place L;,- 720904 Phone - 707/374-281 5 <br /> TYPC OF WELL/PIP�PI REW 'sLL ❑ R_--=AGHEyT L'ELL .( NCMITCRIYG WELL S Cl OTAER <br /> ❑ DESTRLCIIaI ❑ ¢TT-OF-SERVILE WELL ❑ CpE SICAL WELL t '❑ SOIL 6CRIMC <br /> INSTALLATION ❑ tk''J. Smut REPAIR ❑ eROSs-cw4e T REPAIR YAPCR EXTRACID% LE_ d V-6 <br /> .. <br /> New ❑ Repair N.D <br /> OE>TA Kw STT FT. FIRST W,TER L_LVEL to VE�4-1 3 <br /> ❑ . <br /> (TYPE OF PL2W) <br /> arrX ICED USE TYPE OF 7TP-L c0%STiTUCTIDIC SPEC.TKITIONS <br /> 101, <br /> DIA. OF DELL F.t'UVA7Td DIA. OF C:JrwUCYC3 US1NG <br /> ❑ INDUSTRIAL ❑ WEN ii07i CM <br /> GRAVEL PAG/S,= TYPE OF USING/Sic L/PVC PVC DIA. OF WELL CASING <br /> ❑ DaIESTIC/PRIVATE , -- <br /> DEPT% OF GROUT SEAL 30-55/ 1 4-2 sP'ciFIUTICN <br /> ❑ Ubl'C/MiN a ❑ DRIVEN AI GACUT &RAND NAME <br /> G q OTHER <br /> GROUT SEAL INSTALLS &7 r <br /> MCNITCRING <br /> GRalT SEAL pLalpEOt es CNCR£iE PEDESTAL by DRILLER: es ❑ R° <br /> APPSCX.DEPTH 60 LOCING CHEST-CR SCXIS..; PIPE <br /> PROPOSED <br /> CIYSTRUCICIIIDRILL1116 ME;gaa: Is.0 RCTA37_ AIR RCTART�- AU(-.R X CASLe OTRER_ <br /> [ herecry certify that I have pre�red qKCorCYSe with San Joawin Conry <br /> ia aeek:=ctm and that the work wiLL Ix done in v—..i narYB, <br /> Stmte Laws, and RULes and ReSulati ora of the San Jaaeuin Co,,, Mcrae owner or lic__-.^-ed agent's a StD�Ce CJ f+217+Y<S`el i i-"�`. <br /> certify that in the perforear<e of the work for wnich this persit i3 issued, I shall oy mors <br /> arol <br /> Laws of California_' Contract-oris hiring or a. crncnctihQ signator nr:iri<s the fool tLloci n6: • t cert':/ that in -,-ht pe. orsxo <br /> of the .crz for which this permit is issued. I CatL "toy per,°nS strtiect to L^(IKHANhS CCMPENSAT TCR Lays o! Cali'.arnial TAE APPttUXT <br /> MUST CALL 2lytJpURS 1N ADYANG` F9*Ur-,CDUlREO ``i/ECTIDYS AT Q091 4mi-121. C=Lece drawing cat^lower area/Provided. �y L <br /> Date i <br /> Iilllli I IIII II it I illi <br /> IIIIIIIIII I l I { II ilfl <br /> ililiilllil I Illlll- III <br /> IIIIIillllll Illilll i illli � <br /> DEPARTMENT USE DNl7 Are <br /> re <br /> Acplicnci an Accepted Sy <br /> Grout lrapectlon &Y <br /> Date P� in :ion 3y Date <br /> Destruction Irspxcti Pn 6y Date CCPmen U: <br /> AGCJU7IT1116 ONLY- I At" FAC% <br /> PE ODES I FT_INFO AMOUNT RE6fITTa I GIELXJ.-=S% I RECEIVED By OAT I ?SWTl9&Az REDDEST I[UYBER I INYO(CE <br /> I • � I <br /> I I I I <br />