COMPLIANCE INFO_1993-2003 - Laserfiche WebLink

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" WELL! PUMP PERMIT SANJOAQIIIN('OVNTVFNVIRONMENTAL IIEALTD OF.PAR7MENT 304E WEBER A%19 r'FL-STOCKTON CA 95M - (2139)46&3420 NON-REFuNDABf.E PERr4ff /� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRO(M�DATE ISSUED JOB ADDRRt at: 99 ,19 a7 C 6Kl F-� N -J S`17t N ��A m - CrrvrZtr ea k -rer_ 1 3 CRMSTREEr �2•a•/ CZOAO APN A ® & v ` rARc-EL Sns 'I OWNER NAME. _ W_ • vo-`.oma l�C_�`� i2,A t C� PtNMVF O 966 2 OWNER AUDRFQC 99C)9 ZOO-rk I'QkTf" 2L CITY/STATEr/J,- kA _(MA sip ,ONTR ,._# . SqAtlt/ Z- /NF,Qq d- T2,,GTt,14 j ROME 4 -Oh -'3 5 2 . 50Z, 9— CONsnACmRAnDRtxc 2 Zfao t�_-Z INI&_ D(z1VaC -- LVIvrSTATTr/.Ir__, sS/'✓J �J OSE GA j f-kP�� —Y- — SI7B(NUNTMCTOR _{ k�.11I �.PfYVnn/b'R�GpI I.•�A�_.: 'Cy P(I�tDfNE_'_-'IC%�% • ..4r .Q3a SUt)CONIRAC1pR ADDRGCR jL.v 4000 �c • `�v.� taP1Y/STATTlI.IP V A^ Jere CA 7 5 LICENSE CIC -57 O C-61 )-09 O Other __ Nt1oeBEa 6 S_ o EXRRATION DATT. 4 �•DO GF.OGRAPIUCAL INFl(MMATION: CoordhIMM X _ __ _ _ Tewnahtp _t N Rawge Fj_ E Section �- INTP)YnED USE O Domestic/Private O Urigatim/Agrieubutal O bklustrial — O Water Qualik Mositoin g O Soil SarrpbtlgKTfatadaisntiaJ,,,:' O Public Wales System -- S/7Y1 e"dV4e r,; i N(f PILO�j CS r i tfdifrasashaatTwvr. - W'a we. N_ �(,o�sat7t ame ur-CjpoeTi.Mc TYPE OF WORK O New Well O Repqtacemem Well O Well Akaalvm/ModifKa(ioo. 13 Test Ilot- 13 Other— IIEMoaitorilg Wells)--,.wnbn d.el6 O Soil Bring(s) sine, ofbsra,8, OGe fechniral "e'ofavn„p, O Well Destruction O 0u9 -0f --Service Well 11Otd-Of-Service Wc6 Raeewal----- r I ht..... P...e.n t l IN— a -I--- n D....... R....:. rT __ __r:_ o__- WFLLC(W/ MIK.-nON Drilling Method O Mud Rotary O Air Rotary j�Auger O Cable Tool O Push Poet OOtha__ se Propod W.R.. Oerth Z —3 S _ P. - E>cavation s—y ill&—ser O Open Ba tom OOravd Pack / (:Tavel Sit.- t[*.._ifdiameter — O Conductor Casing -in diameter / Coadrelar Casing Derth R Well Caaing Diameter !/2- it Tkichness ,G ge/ASTM Schad $� _ O Steel Jit hastic O Stainless Steel O Omer Groat Seat Depth_ �___ P O Neat Cemem (91 fh flag /?-(0 gel nmfrr) _ O Saul Cement __ sark ais 17 gal wafer Z-BBeatotite(M solids) O Manufatuer Spec% solids Nana— OSpocson Fik OSrocs Submilted (.root Ptacemeot Method O Pumped Free Fall O (Ma _ _ O Retadon(f AccekteMr(namee) PEDESTAL. Installed BY O Dnfkr O Puny, Conufa[IM 1,111me, O Concrete Pedestal Dlmeasi u: Width__ R Length_ .! fl Thick in O Chrfsty Bos )o•Stave Pfpe PUMP QI O S„bmenihle 11 Tufiioe O Odscr _ NP Pump Set _ _fl Standing Water f e.cl _ P WELL. DFCTIR CTKIN O Open Bottom O Gmvel Pack O uncased Q Other _ well Diameter _ in Total Depth_ _ _ fl Derda In Water R O Casing to be Perforated from R b R Sen6 Material O Neal Cemeid (9! fh hag / J.10gn1 water) O Sad C.emcM _ -_—.lark arta/ 7 gal water O Dentonite Pellets O Deamnee (2(r/. solids) O ManufacRuer Spec i solids _— . Name O Spees on File O Sr,ecs Submitted Placement Method O Pumped O Free Fall O Other O Complete with Mushroom Cap _ fl below Frrk O Complete to L istiog Surface Pal I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATIOY AND TIIAT TILE WORK WiIJ. BE DONE: IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS. AND RULES A.11) REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND A " LVE WITH THE CALIFOR.YIA CONTRACTOR% STATE. LICENSE BOARD AND THAT I ABI IN COBIPLJA.NCE WITH ALL WORKERS CO WSATION LAWS. MINIMUM 224 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS )(� DAIT. J Amoant Chak0 Recel"d Date PennW Invoke. Wel IDO Codes (info Rimitted'" .nh 6 ServiceRequest I 1k�0 oggoo 1 t:I It 434)-14XAfa err WoK WcR Pcnm Jac 2/14/2003 MEINIMMUNNIMMMMI Application Accepw By Date 04 Employee We As= 17 cirout Inspection Ily 'aw 13 SPECIAL Well Permit .� 1 Date 13 WAIVER ReceivedDate r. CAMatrUeCd Well Depth ft COMMFYTS Amoant Chak0 Recel"d Date PennW Invoke. Wel IDO Codes (info Rimitted'" .nh 6 ServiceRequest I 1k�0 oggoo 1 t:I It 434)-14XAfa err WoK WcR Pcnm Jac 2/14/2003