Laserfiche WebLink
WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 B6e Ew HAzFLTOH AVENUE-STOOIRON CA 95205.6232(209)468.1420 <br /> NON-REFUNDABLE PERMIT www.figov.O ehd EXPIRES 1 YEAR FROM DATE <br /> �ISSUED <br /> ,Joe ADDRE. `I ( 0. II -- Cm� 952.7—o <br /> DA <br /> '—`— 1 <br /> CavelslREET f'ey�O fO IC l 1. \&I <br /> M00�/v"N0bj-100-1.1'7 PAACELs f.wO U6ET"Ne_ p <br /> O—NAME 1 k 1.11`.Q`y 1rn 1 1 1`yCA06/`�0 rW <br /> PHONE_�n...�- I <br /> 0-A-- l •S V V `•a�T A•1.•� �CM/STATEaW A c rt mVI V 1, CKA I.{ly�{�.�•�l <br /> CONTRACTOR PHONE �ISJ <br /> QONrnACTOR AODREe61g30 -J\ ---, oTY�sTA,E,n.-ma s�_C-ti'53% <br /> SUSCONTRACTORICOMBULTANT PHONE -- <br /> SUWONTRAACr/OR/CONsuLTANT ADDRE88 CRYISTATEZP2 �J— <br /> LICENSE �f G57 C-6, :DOB ,OtheT NtwaEa 7-C10 47 ExsIMTwN DATE <br /> Baum P /M�. OWMIn OMaAGTOR 9WLdfi11AGTONCONBULTANT <br /> DOMEST,c WELL SAMPLING:,i General IneraUCdiform Bacteria(4391)C Dibromochloropmpane(4392)!1 Arsenic(4393) <br /> lrneNDEDUSE Don+eaDcJPrtvate InipeDon/AgriaAWral ❑InduaMel G Water Quality MonfW-dng Sal SamdinglCluratiarhaDon - <br /> Pudic Water S am <br /> 11 e11a�rG Irom Owner. wY STNem Name Cmact Ham.or Paan NYrMN <br /> TwE OF Worth New Wdl Redac W� ,Web AeemtiaJModificalwn a 061ar <br /> Monitoring Wallis) Ro(weW ]Sol Banng(a) a°ISaror _.Geoledmiol adtvry' <br /> out-OI-Se—Well 7 OUFof-SMNw Wag RMMWN r GOm•Connechon Repair <br /> newPunp :Pu u R - u Well <br /> WELL CONsraucrlw y <br /> CaW Tool <br /> Push <br /> ord <br /> �•(�PCt1f <br /> ��-• rropos d Wt eN TDepth Ex—bon .2./ in diameNxL. OPDE Boean �GravN Padc/Cxml Size m diameter <br /> �V 1. ctorr In diameter I Condudor Casing Depth____a <br /> WNI casing TledalesNGaugdASTM SCIcd 'Steel -PlaetIC St-dN Stall - Other <br /> Grout S« R C Head Cement(94 It,b.9*5-I0 0 water) �cement (o.7) sack mix/2 gal water <br /> Sn PlarnnantQM .Pumped ;Free Fag ii ODwr Retardant/I Accelerator(rw*n) <br /> (� fid, By Drier Pump COntractw L Otherfa Pa i-tal�'DI alma:Wkth_a Length a Th4i h Chrhty Box Stow Pipe <br /> 71P "Submersible-Turbine C i OD+er HP Punro Set a SImdIng Water Lead R <br /> IHEREBY CERTIFY THAT 1 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. 1 ALSO CERTIFY THAT hilly REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> R'IN!M11M 46 HOUR ADVANCE NOTIC R UIRE SPE TIONS-PLEASE CALL(209)953-7697 <br /> Cr , DATE -25.21 <br /> r _ T <br /> J <br /> D <br /> 1 <br /> u <br /> N N <br /> DEPARTMENT USE ONLY T <br /> �L <br /> Aplication Accepted By v Dat, Ana N � EmdDyae IDR DA <br /> Grout Inspetllon By , Date I'. SPECIAL Wall PsrTRlt <br /> Pump 1,specfim By. WAIVER Received <br /> Soil BonrlgCln's'pa"cgm By Date CmaI..W Well Depth a <br /> COMMENTS rv'•if �111 /P• I/P C <FFE P OP/YNI}' <br /> • PE SC Received Anrouri Daf• P—Itr Imeica t Wall 10t <br /> Cod- Yio B Cash Ramltad Sarvin t <br /> O -110 <br /> t <br /> Y shp— M.VAMe VQl RIAP PEtiRr <br /> s� <br /> �-J <br /> J <br />