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FROM : M.'E.SEEEECK & SONS INC. PHONE NO. : 916 + 7441408 Jun. 09 2014 11:01AM P2 <br />WELUPUMP PERMIT <br />SAN JOAOUIN COUNTY EMRRONMENTAL HEALTH DEPARTMENT 1868 EAST HA7.eijcw AVENUE - STOCKTON CA 95205 . (209) 468-3420 <br />rvvrv-KtrUNUAet LQYf KMIT I,ALL (ZUS) b53-7697 FOR INSPECTIONS <br />EXYIKES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />/ <br />- �Iy 71 <br />81 risk,, <br />G117111� <br />OiJ <br />CROSS STREET <br />�7�p <br />` <br />�[>')t4�:.�A-(rig . APN 1-5 1 <br />fin. <br />J' 0 — d 'Z' PARrFL $V,F 15'7 <br />LAND U`c.. Apr{ICATION B <br />OWNCRNAMF <br />J�laj.....,d..lt'�I_-7' � �' �.:'S't�S <br />Soil Boring Inspection By <br />0 <br />� JA _ <br />t <br />I <br />OWNER ADDRESS <br />T • �/ I yC I ZJ <br />/PN(% <br />CITY1S TATFJJJ p.}L <br />{IA, Fl EIyCO,� S D 1 Z. <br />CONTRACTOR <br />PHONE A�q�(ZVY—J!V Y <br />CONTRACTORAOIntE.55 O��Glrvr$inrEl7aa�JJl�lr�/17/5b' <br />SUBCONTRACTOR <br />._.. .� . <br />_,.......,.,.-.- <br />PHONE <br />, <br />SUBCONTRACTOR ADDRESS' CITYISTATE/ZJP <br />LICENSE Y -41-57I,< 41 1 0-09 1 1 Ofhcr NUMOER 9Cs 19 7 3 ,FXFIRATION DATE <br />i` a r ui <br />GEOGRADHICALINOORNATION- CoordlrWtvs X 37 •�� IY. Z 1'.l Y (,Zt 2y Z3.'b M) TownehiD Ranoe Section <br />[UMgpgp_Us E Domestic/Privale Inigation/Agnou tUraJ Industrial ! 1 wot- OwIlty Monhnrin9 L SOI[ SamPli%VCharaaefizetion G �� <br />W <br />Public Water System <br />n Alnaont Rom Owmc """"" �r Nx ..n ... on ame or ow Untr yT;' <br />TE OF WORK New Wctl Replacement Well 1 I Well Alleration/MDdifkahon I.. Other ,�..r.. �� <br />1 Monitoring Woll(s) # of wells ll Soil Boling(s) a DO°�" M Gr-DtcchnicRl 3 o x <br />7 Out-OfService Well o Out-Of-Sprvicc Well Renewal I Cross-Connectlon Repair <br />'.J New Pump 7 Pump Replacement Cl Pump. Repair, Rai;;c WL -11 Carina <br />WEIt ComTRUCTLON <br />Drilling MethodxMud Rotary l Air Rotary . I Auer r Cable Tool I t PuVi Point rt Omer <br />Proposed Well Depth_2-00_ft Excavation 24 in diameter 1, Open Bottom )4Crovel PacidGnivel Size in diameter <br />XConductor Casing 2.0 in diameter / Conductor Casing Depth <br />Well Casino Diameter J`L in ThicknesstGa gelASTM Sched .24 011 ,Steel I Pkitdic f l Stainless Steel I ; Other <br />Grout Seal Depth A�;;Q in Neat Cement (9d /D bag/(r10 gar water) L Sand Cement_... ...... ............,_,_,__„__sack m&17 gal water <br />Bentonfte (20% solids) 1'i Other 1 <br />Grout Placement Method Pumped ❑ Free Fall l Other I Rniardanl / Arrclemlor (name) <br />PrO.srAt Installed By Driller 1-I Pump Contractor Othcr <br />Concrofn odQSta imensiortS: WI= _6_,_ R Lang __fe— it Thick �` in Christy Boa I I SIDvc Pipc <br />PtrMP 7 Submers-bled Turbine (101- HP Pump Sct ft Standing Water Level ft <br />1 HEREBY 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. I ALSO CERTIFY THAT MY 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 />MINIMUM 24H RApVA CE NOTICE REQUIRED FOR INSPECTIO S - PLEASE CALL (209) 953-7697 <br />SIGNED '>I TITLE Z>IJ4G .ti DAM �� t <br />A, - - <br />Qlk <br />YME�� <br />IrEIVED <br />DN 10 2014 <br />I q AOUIN COUNTY <br />Received <br />Application Accepted 0Y �_/�'/r" <br />DEPARTMENT USE ONLY <br />v ` Or(�� <br />Arco Q b3 Employes IDiF <br />/�t TEPAf#TIIAENT <br />Grout Inspection By <br />Dote <br />C] SPECIAL W011 Permit <br />Pump Inspection By <br />, Date <br />!�l WAIVER RACoivAd <br />Soil Boring Inspection By <br />0 <br />� JA _ <br />t <br />I <br />Constructed Well De th ft q <br />1"1_� (`;YC L <br />COMMENTS <br />c t K 1 ' <br />S.l �� Gr Lw <br />()1IL�Utic{ Wof <br />cH 41 -CA <br />418012 WELL IPUMV PCRMIT <br />