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18410 WELL/PUMP PERMIT <br /> ,N SOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT - 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468.3420 <br /> )N-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> a ADDRESS 7715 A T RT 99 W- PRnNT RP CITY/ZIP STOCKTON 95206 m <br /> n <br /> O <br /> .055 STREET QANTAR T.N_ APN177-26-014 PARCEL SIZE304.4&ND USE APPLICATION# .Oro <br /> m <br /> 9NERNAME MORADA PRODUCE CO. PlONE546-0426 <br /> 7NERAODRESs 5()(1 N- .TACK TONE Ri)- CITY/STATE/zP STKN CA 95215 <br /> NTRACTOR . Delta Pumo—GTnrRTnN AgmArrqjgp, & MOTOR WORKS �Q.- 209-466-9625 _ <br /> ,ATRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> aCONTRACTOR PHONE <br /> DCONTRACTOR ADDRESS CITY/STATE/21P <br /> TENSE 0 C-57 x C-61 0 D-09 ❑Other NUMBER 724778 EXPIRATION DATE 08/11 <br /> !OGRAPHICAL INFORMATION: Coordinates X Y Township_ Rango Section <br /> rENDED USE ❑Domestic/PrIvate ❑Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> 0 Public Water System <br /> If dlRemnl from Owner: Water bYSCOM Name Loom=Name or Phone Numaer <br /> PE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modiflcation 0 Other <br /> 0 Monitoring Well(s) #of wells ❑Soil Boring(s) #of borings ❑Geotechnical #of borings <br /> 0 Out-OfService Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> 0 New Pump ❑Pump Replacement Ufump Repair 0 Raise Well Casing <br /> LL CONSTRUCTION <br /> filling Method 0 Mud Rotary 0 Air Rotary ❑Auger ❑Cable Tool ❑Push Point ❑ Other <br /> oposed Well Depth ft Excavation In diameter ❑Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing In diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_In Thickness/Gauge/ASTM Sched ❑Steel ❑Plastic 0 Stainless Steel 0 Other <br /> Grout Seal Depth ft ❑Neat Cement(94 lb bag/5.10 gal wafer) 0 Sand Cement sack mW7 gal water <br /> 0 Bentonite(20%solids) 0 Other <br /> -out Placement Method 0 Pumped ❑Free Fell ❑Other ❑Retardant/Accelerator(name) <br /> :DESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> ❑Concrete Pedestal Dimensions:Width It Length ft Thick in 0 Christy Box 0 Stove Pipe <br /> IMP 0 SubmerslbleekKurbine ❑Other HP fi❑ Pump Set 1 40 It StandingMterLevel-5-3—ft <br /> iEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN AC ORDANCE WITH SAN <br /> )AQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> JRRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT.[ AM IN COMPLIANCE WITH ALL <br /> ORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> GNED TITLE CEO DTI 621/2016 <br /> r _ <br /> PUMP/W[LL is located bunk the<ncbsurc - r•,t ,/ 7 <br /> EI VE D <br /> �� �•r �1. `��. E 3 2016 <br /> MACH.AD MP "'NML HEALTH <br /> SERVICES <br /> p <br /> e � -•``y r i RF Y41E D <br /> 16 <br /> M <br /> - — s '`NAS 4 <br /> DFF VRTMENT USE �q'/NLY <br /> Application Accepted By —N�t l/jn/, ' Date-W2/ AreaEmployee IDA�O <br /> Grout Inspection By a Date SPECIAL Well Permit <br /> Pump Inspection By_►&&QO m P Date WAIVER Received <br /> Soil BoringInspection By Date Constructed II Depth. ft <br /> OMMENTSi �/�/y� <br /> PE SC Received Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B ash Remitted Service Re uest# <br /> Woo3a�2Hv a - 790 <br /> , <br /> L408 6 <br /> WELL/PUMP PERMIT <br /> I/08 <br />