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WP0042417
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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GAWNE
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19301
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042417
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Entry Properties
Last modified
12/9/2021 3:27:37 PM
Creation date
12/9/2021 3:21:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042417
PE
4381
STREET_NUMBER
19301
Direction
E
STREET_NAME
GAWNE
STREET_TYPE
RD
City
STOCKTON
Zip
95215-
APN
18514053
ENTERED_DATE
8/10/2021 12:00:00 AM
SITE_LOCATION
19301 E GAWNE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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F \ <br />t r "WELL / PUMP PERMIT <br />.� 4$A-%JOAQUiNCa�X7rEw%atotis>ESTALRE&Li"DEeaxTmc%r SO9]Z4n. U%STRF.Er-STOCKTO.*C;J."M-E-'Y)g40 20 <br />r] <br />YON -REFUNDABLE PER.WT E <br />X <br />PIR <br />E <br />S II�XE.A&RJF)RRom. DATE ISSUED <br />70IrADDR1-ss �/ i (GIJ�(� Ca. `� / �/�!�/ [�" `•'T. <br />CROSSSTSELT �� son► AP�._W �! L�3-: .P.+Rcelsus <br />>a <br />OPV\ER V.1M£j� )� PNO�E / •f', <br />OWNERADISI ESS yd /�VG � �d f <br />B ClTYIrSi'AYFIlIP <br />Goan-%CTOR l <br />CcnzRTCTORADDRE$ D 2— C[R:'SrATFJ7JW� <br />SI:M.bt.TRACIOR Pttrl�E <br />SttiKOAT1tACTOR ADORE96— <br />Lr! t nsE CYIs Ifi7lP <br />❑ C -3i VC -61 d D-09 d NUaMERZ _ <br />E crtretirro+D�r1 �� r <br />uTE!wr. m �[] Dmiic-'m.a - O irte�tiaa APtitu lwa7 d in�ntti3'. O wacr owlity %tw irormg 13 So.1 S3rn hug Ciurcitni-j ion <br />❑ Public tamer System <br />[P= <br />mi Stn: (T+z.^• -� W,C. Srsam \Lms Ccs ?t : w Prrr� �usDt __ <br />..•---• ••M« ....._.. ,...ter vrcepra MM1 WCU U Well Alterdriew-Kodif colon OTWHole dotber_ <br />0 MonitnrhV W-lWS) m air of w:8 d Svil BorinZ,> d Geotechaici scxDc• al sac sg <br />M W di Destnterl 13 Out -of -Sc vice wa i ❑ Ota Of-Sssice Well Rcjxav A <br />O'* -g' Pomp Jo P+ma Rcnlzc.-mrnt d Puma RCPair d Oros - oam=im 3epvr <br />WELL COaSIRt.CT101 <br />Dr@ ttg Method d Mud Rotary 13 Air Roary d Anger d Cable T01 d Push Pout d Other <br />Pr *ru Japth —_ R Excavation in, awleler O Open Hrmom d Gravel Pack t Gravel Size is diameter <br />Q (emLt - Castng in diamt cr ! Conductor Casing Deprh fl <br />Hell Casing Dimaokr—in Tbickrrr-scr. a ASTM Seised d Stcei d Plastic d Srainksc Stcel d Ch)er <br />Great Seal De-ptb It O %at Cement r9d lc lw3 ; i-16ga1 te�teri D Sand Cm= rack mtr: 7 gal water <br />❑ flCM11he t2iY.; solids] d J1 outfactsr Spee "fi =ol is _ ".a %mc _ <br />GradPtae�]cred d Pmpcd d fze faid Gard Spss oa Fila a SpxSSubmittcd <br />13 3Aecao(tan) <br />PEam-IL tesrmtld ®v d nulla ❑ Pwnp Contractor d Other— -•— <br />❑ Coacrste Pedestal Dimensions: Width T ft Length_ ftThick d Christy Bos d Stow <br />Pump ❑Submersibic QFurhinc OOther HP PuagrSet t3 StadingWatrrLe 9 4 <br />WELL UrbT UCHOA d Open Ballow Q Gravel Pack d T:nc:rsa (7 Orhtr' <br />Well Dialmr— in Torsi Depth ti Depth 10 W=Lr n d C;siog to be Pcrfcval-d frac —_ it to t} <br />SeeYmg Xxterial d %cat Cem-m 6W lb dug. 5-1rl-w1 rra" ❑ Sud Cemscat ractnir; i mai w"m G Reamniur Pellets <br />O Bcmeoile 12ffi. solids) O Matntf2c%w r Spzcc % solids ".; Nam-_ i3 Specs on Fila d Specs Submnwd <br />Prnement Method 13 Pumpcd D Fra Fall d Other _ <br />'C' Complete cvith'busbroom Cop 11 txtow ata& d CoUtpic e w Exi sting Swine Pal <br />I HEREBY CERTIFY THAT I HAVE PREPARED TRIS APPIJCATIO.N AVD THAT THE {PORI: itIU BE DOME LV ACCORDANCE WITH S4.V <br />3OAQL'L'E COU. -TV ORD \CF. STATE L.aW'S. AVD RULES A.NM REGULATIO\S I ALSO CERTIFY THAT Ally REQL9RFD LICENSE IS <br />CURRENT A%D aG CALTFORi3a, COVTRACTORS STATE LICUM BOARD A -ND THAT I AM IN CoNpi.IA%CE WITH ALL <br />WrOR1�tS CO j� <br />StCtrED_ •Iylly/li DATE <br />ApplicatwoA—ptedDy 4-4-uarwecr �r■ �y_� ea "i pi2gomftum / � St° <br />Cantil Inspection, M. ._ Dam 0 SPECIAL Kea Permit <br />Pomp laaFcction • 3an;A-Q�'u Q WAn-ERReceived <br />DesmrctionYn. ciion RY Dau; Constructed V!'eil Yh _ tY <br />COIrIIrENTS 0 30 <br />9:1 11200 <br />R-ei rv-m and Dcevrati-& . <br />ft <br />ri <br />RECEIVED <br />AUG 10 2021 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />
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