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SAN <br />0082 'ON AMI:01 LI 6 'H";a 'I'll <br />WELUPUMP PERMIT r 0 <br />COUNTY ENVIRONMENTAL HEALTH DEPARTMENT less EAST HAZELTm AVENUE -STOCKTON CA 95205 -421)9)468,3420 <br />NDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />16788 Comstock Rd c,,vzP Linden CA ()5236 im <br />T Tully Rd APN DRQ' � ya � 17 PARCEL SLn . / LAND USE APPUCAT1cN # g <br />!� A <br />A vansino T2 pliON[�"9-887-3414 m <br />ss�b�£38 r Comstock Rd. crTTjs 7sz,PLinden CA 95235 <br />Purviance Drillers, Inc pHONE209-887-3554 <br />ADoREss P O B o x 64 CITY/STATEMP Linden , C a 95236 <br />SUBCON CTOR PHONE <br />SUBCONTR CTOR ADDRESS CITYJSTATEOP <br />L iamss 1 (O -S7 ❑ C-61 7 D-09 0 Other NumaER 377923 F..RAT.ON DATE 7/31/19 <br />Do%iEsTIC L SAMPLING: 2 General Mineral/Coliform Bacteria (4391) L Dihromochloroprapane (4392) 7 Arsenic (4393) <br />INTENDED U e O DomesticrPnvate ►lrrigationlAghcullural D Industrial G WaterQua1ty Monitoring D Sail Samplingr-hamciedzeGon <br />D Public Water System <br />Irdtlferenttram Owner. Wader System Name ConleR Name xPnane Number <br />TYPE OF Wg RR P New WelI G Replacement Well D Well Alteration/Modi kation 0 Other <br />D Monitoring Weil(s) A of wells G Sal Boring(s) $or bawds D Geotechnical Corm i qs <br />D GLI -Of -Service We■ D Out -Of -Service Well Renewal D Cross -Connectior. Repair b <br />F1 New Pump n Pump R la: ement P. Purnp Repair 0 Raise Well Casing <br />WELL CONS UCTiciv <br />A Drilling M a hod E Mud Rotary C Air Rotary D Auger D Cable Tool D Push Point :1 Other <br />Proposed ell Depth 4S_0 ft Excavation I f r t in diameter * Open Bottom D Gravel PecYJGravei Size in darneter <br />❑ Conductor asing in diameter ! Conductor Casing Depth R <br />Well Ca ng Diameter In Thidmess/GaugelASTM Sched .1-6" $ Stec D Plastic C Stainless Steel U Other <br />Grout 1 Depth IOC f) it C Neat Cement (94 fb beglSlO gal mater) * Sand Cement 10- 3 sack rriV79 al ureter <br />0Bentonite(2C%solids) 6Oher <br />A� Grout Placiment Method t3 Pumped f] Free Fall =Other D Retardant /Accelerator (name) <br />WPEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />WD Concrete Pedestal CDimensions: NFdth ft Length ft Thick in D ChristyBox D Stove Pipe <br />PUMP 0 Submersb!e0 Turbine D Other HP Pump See ft Stand[ng Water Level ft <br />W 1 HEREBYCERTIFY THAT I HAVE PREPARED THISIO <br />APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />IOAQUIN UNITY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />M NIM 24 H AD ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED,GLIivLs-rcG TrnE C o r p o r Sectary <br />NLY <br />Accepted ByA,,_�RTMENT(Usl <br />Date Z <br />Inspection A Date <br />Inspeclian Date <br />----- ------- <br />I� I. <br />■■■■ MIMMINIMER. <br />�d <br />■ <br />paAIaaa� <br />E1111414e 1111/11, OW. W. <br />V'd VLSCL2260Z <br />WELLIPM? PERMIT <br />oUJ Sa011iaQ eOUeiAand e9Z L L L L 6Z 080 <br />