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i <br />WELLIPUMP PERMIT <br />SAN JOAQuw COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1999 EMT HAzeLToN AvENuE • STOCKTON CA 95205-4232 (209)461111a&120 <br />JosAamtesa 1010 Industrial Drive clTyrp Stockton. CA 95206 <br />CROa%STREET S Airport Way APN 177-280-130 PARCELS119.6 aCLANDUsEAPPLWATIONO <br />OMERNAME Inaredion. Inc. PHONE <br />OWNER AccaEss 1021 Industrial Drive cm,sTATErrp Stockton. CA 95206 <br />CONTRACTOR Exploration Geoservices. Inc. PNONe (408) 280-6822 <br />CONTRACTORADORees i!35 Ind IS ria) Avenue Cm15TATLrzP San Jose. CA 95112 <br />SUBCONTRACTOR/CONeULTANT Comerstone Earth Group PHONE (40R) 245-46OLI <br />SURCONTRACTOR/CONSULTANTAommss 1259 Oakmead Parkway CITYrsTATErz[P SUnnVVale. CA 95050 <br />LtCENeE XC.57 _ C-91 i D -0N Other NUMBER 4842AR ExvwATION DATE <br />BlIl PARTY: -1 OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPUNO: D General MlneraUCOhforrn Bacteria (4391) 0 Dibromochloropropane (4392); 1 Arsenic (4393) <br />INTENOEO Us& DamesSdPdvale :' InipatiorvAgriadhrrat , i Industrial Water Oualiy Monitoring (:Sod Sampli ng/Charecterizadon <br />I Public Water System <br />D davem earn Owner W,ter srNem Nurse Cemad Name or PhWo Number <br />rin OF WORK ': New Well Replacement Well I1 Well AtIerallon/Modifleation n Other <br />Motitorurg Wegs) S or wets X Sall Baring(s) • 010o^"s' x0ectednnical 1 s or bwhVs <br />Oul-0f-Service Well I I OutOf-SeMce Wei Renewal Croes-Connodlon Repair <br />1 New Pumn I I Penin Raeretwmenl r t P.M. Re.eir n Raise t/vwn Caslnn <br />Drilling Method : I Mud Rotary (i Alt Rotary XAuger i) Cable Tool r Push Point 7 Other <br />Proposed Well Depth 45 It Excavation 8 in diameter D Open Bottom I i Gravel PadVGravel Size_ in diameter <br />11 Conductor Casing In diameter 1 Conductor Casing Depth it <br />Well Caeing Diameter _ In Thickness/Gauge/ASTM Sched n Steel , Plastic (! Stemless Steel r; Other <br />Grout Seal Depth h JN Neal Cement (941b begrS TO pat water} 7, Sand Cement sock n ibrn gal water <br />i I Bentonite (20% sotki<) l Other <br />Grout Placement Method � ) Pumped I Free Fall A Other ?) c",tit 1st 1 (I Retardant / Accelerator (name) <br />PEDESTAL Installed By 1 t D61W I I Pump Contractor 0 Other <br />I i Concrete Pedestal CDlmensions: Width 11 Length N Thick In Christy Bos c Stove Pipe <br />t Submersible: i Turbine 1 Other HP Pump Set 11 Standing Water Level It <br />I HEREkAND <br />IFY TH HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />HEREBY <br />TY 0 NANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURREAC WITHZ <br />LIFORN1A CONTRACTORS STATE LICENSE BOARD AND THAT I AAA IN COMPLIANCE WITH AL.L <br />WORKS ON 48 ONCE NOTICE REQUIRED F NSPECTIONS -`PLEASE CALL (2092 t <br />ms■ ^ <br />3.76 L.\ <br />StONED TITLE,0 DAIS �{. t� V <br />DEPARTMENT USE ONLY <br />Application Accepted By Date / % .7 Area.; b '�y 4i J/"Employee IDS <br />Grout Inspection By cit Date 1 2A r! SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soo Borbv I�s etllon By 1� Palo Constructed Well Depth It <br />COMMENTS r /t'M 1+4 eL D OF l ` hF F'4 Y�rt►' �^ <br />Flip a] -Oe an,no,s/ w � I�/,2— �� wEu+PurP PERun <br />