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Address: 25850 Sowles Rd, Acampo <br />ID: WP0042426 <br />3SS 23�dj <br />WELL/PUMP PERMIT <br />IN JOADUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1066 EAST HAZELTON AVENUE - STOCKTON CA 96206-6232 (209) 466-3420 <br />r..r ..__.._.. _ _.. _r__.......1-11 FYpipFS 1 YEAR FROM DATE ISSUED <br />SADDRESS/! L�J�V CITY/ZIP �- <br />OSS STREET �-✓ A� APN _ 40 PARCEL SIZE LAND USE APPLIC0 <br />/ATION 1 r� <br />PHONEf 7 <br />'NER NAME 6 �IL [ U �- / <br />NER ADDnegs 3 CIN/STATFJZIP �/ JI <br />/, � PHONE � <br />+TRACTOR G9 -- <br />L-1 /l1-1: x/ <br />ITRAC TOR ADDRESS /!J2 '19'c'/ ` CITYISTATE(ZIP (�/ ✓- <br />PHONEE , -7 <br />CONTRACTOR/CONSULT�� <br />ANT <br />:ONTRACTOR/CONSULTANT ADDRESS CITY/STATEIZIP /+ <br />v5E pQ;-67 CI L'•61 IID -09 Cl Oliver <br />NUMBER '27V .1. E%PIRAT/ONDATIE <br />..nurnA. - SUBCONTRACTOR/CONSULTANT <br />=STtc WELL SAMPLING: 1 I General Mineral/Coliform Bacteria (4391)' Dibromocl oropropane (4392)' ; Arsenic (4393) <br />beo Us- e � sllefFdvate P Inigalion/AgncUllural r] IlxluslnAl n Water Quality Monilodng U Soil SamplingtChamctenrallon <br />D Public Water System WAIersw... N,vrm CnnIALI Nome or PAone Numixr <br />If AlRerenl hom Ovnwr: —� <br />IP WORN % New Well n Replacement Well rl Well Allel a11on1Modi6callon I] Other _ <br />#.14minys O(3—technical____#nr IUAlnOe <br />t'I Monlloring Wells) X of wells n Soil 90ring(s) <br />U Our -Ol-Service Wefl n 0111 -Of -Service Well Renewal f Cross -Connection Repair <br />NoYew Pump U Pum r�Replacemenl CI Pump Reoah <br />lJ RRlse Well Casino __� <br />DNSTRUCT10N <br />Method �1ud Rota//ry.-�� r.7 Air Rotary n Auger Cable Tool LI push Point L.I Other <br />d Well Depth,y3,� It Excavallon _E=. to diameter Li Boftom i<6ravei Pack/Gravel Size In diameter <br />D Condudg In dinmeier / Conduclor Casing Depth R <br />ur <br />sing., 0;anrele ions <br />Thickness/Gauge/ASTM Sched W) U Sleel 1(,Piaslic n Stainlesls7Steel U Other <br />- _ <br />A n Neat Cement (9411, b.91.5.10 gat walar) ,�tC'and Cement �✓ • sack mfxn gal water <br />Seal Depth <br />t I Ben(onilc (20% solids) U Other <br />mend Method Kaumped U Free Fall D Other [I Retardant I Accelerator (name) <br />Installed By a'l't-0filter U Pump Coniraclor U Other _ <br />U Concrote Pedestat ODimenslons Wrdlh_ fl Length�-- fl Thick In I7 Chrlsly Box U Stove Pipe <br />t�Sub1P7.ibteO lurbine IJ 011ier HP rump Set (t Standing Water Level ft <br />RTIFY THAT I HAVE PREPARED THIS APPLICATION- AND"THAT THEWORKWILL BE -DONE 1147 ACCORDANCE WITH -SAN <br />JNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />D ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />1MPENSATION LAWS, A <br />IMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />/So - <br />17e-- les- <br />/ 626— 21 0' c__ �—' I -q <br />CZ17 <br />-2,61- Z-7 5- 6tLAt& 1, <br />2.74'— <br />Z 9d-3 66_ (3"L,6 Z <br />3 Z3- 7 <br />3 z el— 3 S <br />(-7-xx <br />Naseem Ahmed, Registered Environmental Health Specialist <br />