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WELUPUMP PERMIT <br /> SAN JOAOVIN COVNTT ENwROr1Me NTK HEALTH DEPARTMENT ISN EAST HASELToN AvENue•STOCKTON CA 95205 4232(2011)4"•3420 <br /> NON-REFUNDABLE PERMIT www.s Oy.O •hd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe Aooatu 19RO nnyA nrive dTv/DP Tracy,CA 95376 n1� <br /> caow sTr m RavAn Court APN 24204023 PARCEL Sal_I-L_LARO Ust APPUCATrON s <br /> OWNER NAME racy Unified School District PHONE 209-830-3200 <br /> OWNER ADowmas 1875 W Lowell Avenue _ CrTT/sTATEa. Tracy,CA 95376 <br /> CONTRAcToa Middle Earth Geo Testing, Inc. PNom 714-633-5025 <br /> CONTRACTOR AODREas 954 N Lemon Street _ _ CITYISTArErbP Orange, CA 92767 <br /> SURcoNraACTORICONVATANT RSK ¢S -iatec pww 916-853-9293 <br /> SUI CONTRACTOWCON1ULTANT ADOREss 3140 Gold Camp Dr.#160 CI"ISTArEzp Rancho Cordova-CA 95670 <br /> E -A <br /> Ucii.l C-5. C'-Fl t D-09 _ NuvwR 899451 EAPIr1AT10N DATE 06/30/2021 <br /> l&LUNOPART1. OWNER CONTRACTOR SU6C091`RACT0R/CONSULTANT <br /> DoMEsTle WELLSAMPUNO: General Mrneral/Coliform Bacteria(x3911 Dibromochloropropana(4392) Arsenic(4393) <br /> (NTENoep URE DomesIj 'Private Imgatutn'AgrKlltural Industrial Water Quality Mon,ttwing ,r,Soil Samp4ng,Cturacteriz3bon <br /> Pubic Water S(slam _ <br /> Y co—tram C.ne WANT ST.—1r .4— <br /> TT►E Or WORN New Well Replacement We4 Well ARoravon,AlodSc&wn Othe, <br /> Mun&.ng Wew sl a or wets Sal tionngi s) °—N, X Ce tocnrvcal_�_•NLv.�gr <br /> Out-of-Service Well Ovt-q-Semce Well Renewal C owConnecbori Repair <br /> New Pump Pump Raplacemem Pomp R",r Race Well Casng <br /> WILL C� o"TKucTaN <br /> Drilling Method Mud Rotary A✓Rotary :{Auger Cade Tcol Push Pc,nt Other <br /> Proposed Well Oepin 50 R EAcavatan 1-5 in diami Open 5'Alom Gravel P&dvGravel Size_in ClamMRr <br /> Conauctw Caveyl a+aameler Conouctor Casing Pepin R <br /> Well Casing Diameter in TI-ckresslGauga.ASTV Sated Stell Flasbc Stainless Steel or Ar <br /> Growl Seal Depth 50 R X Neat Cement(44 11)bays TG gal 4161) Sand Cement sack mrr7 gal water <br /> Benh"IL.,20%colds) Other <br /> Grout Ptacernsnt Method Pumped Free Fall :S other GPT rOCIS/trerl i Retardant 1 ACCelersWr(n4rno) <br /> PE0E/7K MstalHd By Driller Pump Contrwtw oi-w <br /> Concrete Pedestal Dknenslo Wldlh R Lergth_ R ThcA n Christy Bot Store Pipe <br /> PUMe Sunmemkda Tum.ne Otrxr HP Pump Set _ 9 SLn ding W"r Levet_ R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> IOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMP N ATI IAINS. <br /> MlN1W I UR n NC OTICE REQUIRED F INSPEC IOISI�•PMA r,SE CALL(209)953-7 97 <br /> ymD TRLE �WIWI it ` K n ATE D <br /> I � I <br /> i I <br /> I <br /> I i i <br /> I I <br /> i <br /> Pq YMEN <br /> � FCEI V ED <br /> 3 0 ?0?0 <br /> A QL/1N <br /> - CCU <br /> E ARTMENrV <br /> DEPARTMENDateT List ONLY '1' <br /> Appl,CaWn Accepted By /L'L'L-� Area <br /> /f�t L, Employe6 lDR � <br /> Graft In..specbon By Date SPECIAL W911 PWITIlt <br /> Pump Inspection By Date WArvER Roedvod <br /> Sol Boring Inspecyon By .,i.l i..'`( _ Date g 1,/ Constructed Wes Dpth h <br /> COMMENTS <br /> 1'E Sc Rewiredc Amount I Dar Imolp r W611 IW <br /> Codes kdo RwnRtad Service Request <br /> I SO S� <br /> I <br /> V,D kion 81,7o.r WELL~PEV"T <br />