Laserfiche WebLink
Site Address: 10980 Hwy 12, Locke rd CA 95237 <br />Date: 8/5/2020 <br />PHOTO # 1 Well Loa. New Well Grout with sand cement. Seal set from 200 ft. <br />f <br />r° xxiFi <br />Record ID: WP0040998 <br />viii <br />a, <br />i All <br />„. <br />at ` <br />All <br />3 <br />a 11M.o <br />WELL/PUMP PERMIT <br />SAN JOAQUIN CoLl ENVIRON H�PARTMENT 1868 EAST HalAVENUE.STO,. � <br />�ICT°N Cp 95205 6232 (2o9j 46&3420 %% _ <br />NON-REFUNDABLE PERMIT WWW' OV.Of lehd / Ex RES I YEAR FROM DATE Is SUED <br />CrI <br />JOB ADDRESS O� G �. <br />CROSS STREET (( // /fS I.�� APN O�"lii J�6 PARCEL SIZE L4NpU5EAppLICATION# m�/' /'� <br />OWNER NAME i2AI✓jti� L -L /V/•r 7�VCU�'L+ PHONE �Z�--Q�33 /' OjC-f G <br />OWNER ADDRESS e (�/�/��/y^{�,, inn /^)n � y 1 _ CITYISTATEOP. N U' 1I / v- G <br />CONTRACTOR L/� A \_Ja(!L > DoZ lA/ .5 � Y ZS�• {.. <br />/ <br />NONE <br />CONTRACTOR ADDRESS L CITY/STATEZP [�J 8T/ //y 1 t, (7z/ <br />SUBCONTRACTOR/CONSULTANT j f�.n� PHONE `7 <br />SUBCONTRACTOR/CONSULTANT ADDRESS `�C'I'T�YI'S7TA�TFJ�%I(P ' <br />Ig LICENSE �G57 ❑ G67 O D-09 ❑Other NUMBER �! (_y2_'�.=_ Ex?IMTION DATE 2/ 16! C <br />f / j <br />E31LLING PARTY: D OWNER D CONTRACTOR ❑ SUBCONTRACTORICONSULTANT / CI'_ L7 6 •(•lam/•+/-%/'/� <br />DOMESTIC WELL SAMPLING'Veneral Mineral/Coliform Bacteria (4391) Dibromochloropropane(d392)❑Arsenic (4393). p1 IpS <br />INTENDED USE �Domestic(Privale ❑ Inigation/Agricultural O Industrial 0 Water Quality Monitoring 0$oil Sampling/Charactedzahon � 6� 26a G647 ••��"" J <br />-` D Public Water System / `� , y/ <br />_� Ir Elrterenl from Ownef. Water System Nsme 0018d Named Phona Number kJJ ���V�- <br />r +'y♦"`"� ' TYPE OF WORK ^eW Well 0 Replacement Well D Well Alteration/Modificatlon ❑ Other <br />#of bodngs #orbodngs 21 �3 2 — Cowl <br />0 Monitoring Wells) # o(wells 0 Soli Boring(s) Cl Geotechnical <br />❑ Out-0f-Servlce Well ❑ Out-Ot-Service Well Renewal 0 Cross.Conoectom Repair lJ7 ? <br />y , / <br />t'f"44 � , . ` I' ew Pum D Pum Replacement ❑ Pum Repair ❑ False Well Casin - ' 2i (��, <br />WELL CONSTRUCTION 1, 2 •• ZS <br />Drilling Method >iud Rotary ❑ Air Rotary ❑ Auger ^ 0 Cable Tool D Push Point ❑ Other m diameter <br />tr Proposed Well Depth _ft Excavation -Ol..--- In diameter 0 Open Bottom �`'iIa PecklGrevel Size r <br />Ar ; <br />0Conduct Casing In diameter I Conductor Casing Depth it <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched � ❑Steel plastic 0 Stainless Steel D Other. <br />A !'� sack mix/7 gal water <br />Grout Seal Depth? OO ft ❑Neat Cement (9416 bagl5-f0 gel wafer) �p Sand Clement— J N <br />❑ Bentonite (20% solids) ❑ Other l` _ �i JL�02 <br />Grout Placement Method jRTumped ❑ Free Fall ❑ Other 0 Retardant/Accelerator (name) <br />PEDESTAL Installed ey filler ❑Pump Contractlo� / 0 Other Christy BOX <br />D Stove pipe <br />0 CO - - Imensions: Width _Z ft Length in 0 <br />-�- ft Thick <br />Other HPSlanding Water lleveln ft <br />MP Mn Twe Acral v.TL,.r Pump Sel_�ft^ ue IN AOCJ�?QgNA �olaHatn N(name) ---�I <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />Y <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />