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WELL/PUMP PERMIT <br /> SAN JoAmm CouR ElmRommFwK HFAI TH De►urttiex- IOU F sT HA Tm A.F"-Sr—CA 95205 4232(209)468,11120 <br /> NON-REFUNDABLE PERMIT www.9fgoy.erg/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jm AOOREss 'L n HV,-1 FI boys Port of Stockton C"/Z. Stockton 95203 ,yP <br /> CAosa STTIEE'T C(flf]11V41' I67 E 611ee PN--16203007---Prlcel Sra 1372 LAwo USEA—A—• N/A <br /> q.fa w.LE Pott of Stockton PNS (209)946-0246 <br /> Ow lx AOOREss PO Box 2089 CS"ISTATUMP Stockton,CA 95201 <br /> CO.'I TOR Geo-Ex Subsurface Exploration P„e,E (916)799-8198 <br /> 'CONTRACTOR ADDRESS 1510 Madera Drive CArYYIETATFJZP Dixon.CA 95620 <br /> "CON-RAOTDR/CONSULTAKT N/A PHOS <br /> SIIBCONtMAC'p/Cp I TAN1 ADO W CI11STATEIZP <br /> 'Uct.s ;:r,57 C 6T D-09 10011 NUMBER 951267 EWIP IDN DATE 7/31/2020 <br /> BILLWJ PAR": OWNER OCOMMACTOR 1,SUBCON.RACTOR/CONSULTANT <br /> DOULSTIC WLLL SxMPUNG: General Mineral/Colrtonn Baclena(4391) Dibromorhloropropane(4392) Arsemc(4393) <br /> 'DomcflnT'rr.pla Imp.trorUAgn[ul9rral _IndustrW .'WA.,Ou.Iey 164—w-9 .1 Sai g.mpl,,,ryCnaractcrtulron <br /> PUCIK We1cr Sysbm N/A <br /> r er'e <br /> "V-0—O.,rr WY.er SyKrm Nwne C-y N—d It—W-W <br /> TVEOFWOM UNew Was R.Ow-ermm Well IWell AWmboNMoalhciI xcxnor 39 Cone Penetration Tests <br /> Monitomg Wefl(s) N orweib ':Sod Bonrlg(s) F°b—ge 2 Geatecnncal <br /> out Of scmcc wen Out OI-Scrrxe Wcll R.--i :I Cnv-C.-w—R wu <br /> Nnrr Pump Puly Replacn r.! -.Pump Rc y Raw Wom Cm, <br /> WELL CONS'RULTION <br /> Dnllmg M.thod IAud It,n.ry Air HULrry Au9a1 . Cabk ll.1 Push PORE N Omer Cone Penetrdt—Tes:(dllect push) <br /> Proposed Well D.pin 200_M Ex .bon 2-5-in .n aamala D open Bottom Gravel PxvGravol Sea N/A m aamola, <br /> conductor Cas.nq N/A mnwww i comumlw(.mwq Depth N/A n <br /> Well Calling 0—ter N/A m TMckm%s1G.lW1ASTM Schad N/A C Stool P.rlc i St.lnbss Sl.ol i Other <br /> Grout Sul Dapin 200 M 9 Nwt Cement(94 D bags 10 gal wuex) Sano C' t sac*man gal water <br /> :7&:MIXIRa 120X solms) pt Oth!rGeotachncal bcnrgs aW CPT hobs wal bo baddillod(soalod)wah benlurato 4oul a nwl txrrCni- <br /> Grout Place"m Method ':Pumped I Frog Fall :9 Other Tremie tube : Retamiarx 1 Accelerator(rtanx:) <br /> ja=A:& Imtelled By pr:scr P mp Corxramr Other <br /> Cmcruts Pedestal t.DIDlsnslonr Width :", ;erglr M Thick m Christy Bos SWre Pope <br /> tel: Sudmrslble Turbme Other HP Pump Sat M Standing Water Lovol It <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 IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPEN3/LTLON LAWS <br /> MINIMUlIe4il H' JJ ' _ '-iaLCWRED FOR INSP�CTiONS-IP LLEASC CALL(209)953-7 97 <br /> SroNED T". 1�('PSI`r{`f1.lt�S DATE 1 <br /> I <br /> ' REq YMF <br /> cF��Nr <br /> - - - s Fo <br /> Fp 09 <br /> 7 - LIA/04 <br /> T�yOEAq��4� <br /> 77 <br /> � MFNT <br /> I I <br /> DEPARTMENT USE,ONLY fir/ <br /> �:._--_/� Dale J+b A.. fJ'-^7.?7t<mpbyou Os—,D <br /> ADDLGIIIXt ArioDled ey-_.. _ _ ,-,1/ <br /> Gmut Impecton By onto _ SPECIAL Well Perrnit <br /> Pump ImIlwon ByData WAIVER Received <br /> Sou Bomgrmpoao°By Dam\\`\\% u)L'O. Con.uucted Well Depth n <br /> COMMENTS r f J:'Ft, _'I c�ve IGVA C. <br /> M -. °tt�c -A. 1 0 — <br /> PE CIC Reeelwd CIwe1W Amount Mrtnkl <br /> Codec MIO Cash R.mttted Se R u.el/ Mrolp N Wae IDBLAD <br /> t' <br /> �\ 1 \'i-,2A'Lp <br /> Lron.x mrmm <br />