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JOB ADDRESS 21000 Mountain House Parkway crryizi, Tracy, 95391 <br />OWNER NAME Maninder Sandhu <br />CROSS STREET West Grantline Road APN 209-150-ift 9.' ::: PARCEL SIZE 3 ii" LAND USE APPLICAMON # <br />PHONE <br />OWNER ADDRESS 3972 West Durham Ferry Road CITY/STATE/ZIP Tracy, CA, 95304 <br />Galt, CA, 95632 <br />PHONE 916-767-8082 SUBCONTRACTOR/CONSULTANT Mid Pacific Engineering <br />CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP <br />4/30/2022 EXPIRATION DATE LICENSE V C-57 C-61 0-09 Other NUMBER 720904 <br />CONTRACTOR V SUBCONTRACTOR/CONSULTANT OWNER BILLING PARTY: <br />Pump Repair Raise Well Casing SS3NOCIV 311S New Well Replacement Well <br />Monitoring Well(s) # of wells <br />Out-Of-Service Well <br />New Pump Pump Replacement <br />111 A ( (21 <br />e:- <br />PAYMENT <br />RECEIVED <br /> OCT 04 2021 <br />V I <br />WELL /PUMP PERMIT El-ID 43-06 6/11/2010 <br />V ,Cp4OTICE REQUIRED FO,F.Z.INSPECT,LONS : PLEASE CALL (209) 95-7697 <br />TITLE -)k C4.4. DATE \ <br />N JOAQUIN COUNTY <br />pVI1ONMENTAL <br />EALTP DEPARTMENT <br />SA <br />DEPARTMENT USE ONLY <br />Application Accepted By „,_./' Date /) / <br />Grout Inspection By R Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received COckiri <br />1 C sh 1 <br />Amount .Remitted Date Permit/ <br />Service Remest # Invoice # Well ID# <br />,137a Igo vl $ qs‘ 10'1 ZI v\WOOL424 I 2-) ...... <br />11.1 <br />Area 5/ / Employee ID# <br />MINIM• <br />SIGNED <br />HQIUR A <br />fr1/444., <br />TYPE OF WORK Well Alteration/Modification Other <br />Soil Boring(s) # of borings V Geotechnical 1 # of borings <br />Out-Of-Service Well Renewal Cross-Connection Repair <br />V & W Drilling Inc. PHONE 209-369-9600 CONTRACTOR <br />SUBCONTRACTOR/CONSULTANT ADDRESS 940 Embarcadero Drive, Suite 20 CITY/STATE/ZIP West Sacramento, CA, 95605