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Site Address: 18933 DeVries Rd, Lodi CA 95242 <br />Date: 7/15/2020 <br />PHOTO # 1 New Well arout seal from 100 ft to surface. Well <br />Record ID: WP0040960 <br />1 <br />Y ra,,r 0 Pump Contract ❑ <br />ectal DDlmanafons Width g <br />Turbine ❑ Olher _- HP <br />erdOnt /Accelerator (name) 30 7 -�7- 7 - -1440111f/ <br />(5AA 14 C <br />_ ft Thick In 0 Christy Box D Stove Pipe <br />7 / <br />Set ft Blanding Watar Laval n .� %i CL .'rr <br />ameter•eL in Thickness/Gauge/— AS <br />Depth /8 a ft ❑ Neat Cement (94 Ib bag/5-10 gal <br />D Bentonite (20% solids) ❑ Other <br />­ar I /n.i........1 n C..... Cell n /lther <br />ri Rpfarrianf I Arrplpratnr Innmp\ <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />1868 EAsT HAZELTON AvENUe - STOCRTON CA 95206-6232 1209)468-7420 <br />- NDAeLE PERMIT <br />n <br />Nor <br />__ WWW.a Ov.oT /ehd EXPIRES I YEAR FROM DATE ISSUED <br />r - Z e.- $,( AZ <br />JoeI <br />Joe ADDRESS � i <br />� <br />CmZPtt�V <br />CROSS STREET / 0)3 oya 10 <br />N <br />s <br />r <br />AP PARCEL SIZE APPLICATION <br />OWNER NAME <br />�C <br />6l�' V <br />CROS <br />O(./ ('� (� <br />7 -7 - 3 i i 7 <br />- <br />OWNER ADDRESS <br />CITYISTATEZP <br />/+ <br />NV P- <br />OWN <br />� <br />CONTRACTOR _Dif y /' V/ ` <br />,�lL � //- 7 ! ZS <br />�, 1 1 �a ///1 <br />�//� �i� U � <br />CONTRACTOR ADDRESS /LZ �496e� x CITYISTATEZP� j* � <br />SUBCONTRACTORICONBULTANT r%) r iM" <br />J��R./OWN. <br />CON <br />, Q i ,-212oT <br />Z-%' J <br />�/-�NSUBCONTRACTOR/CONSULTANT <br />ADDRESS CITYISTATEIZIPxCON <br />pS <br />O♦¢C-57 O C•61 ❑ D -G9 ❑ Olhe( NGMeBR 377.30 DATE _ ( �•i.i� <br />.y?C'- czQ�LICENSE <br />/"r.wSUB <br />BILLING PARTY: I.1 OWNER 9R oNTRACTOn D SUBCONTRACTORICONSULTANT/ <br />A// <br />�] .v <br />-70 _ Za 7- S -A <br />SUE, <br />DOMESTIC WELL SAMPLING: D General Mineral/Coliform Bacteria (4391) G Dibromochloropropdne (4392) O Arsenic (4393) �7q <br />INTENDED USE rivals D IrrigatloNAgrlcuMural Industrial <br />ZC%O�-' i-? <br />"{ <br />LIC <br />D 0 Water Quali Mentions c <br />ti 9 DSon SartphnglCharac eriz C c <br />OPUDIIc Water System <br />J <br />• <br />e UMerenl ham OneRr., Wnv Syabm Name �—Cailacl Norte <br />(l/� <br />- <br />BIL <br />a PY.w Number <br />TYPE OF WORN 4e41ew Well 0 Replacement Well O Well Akeratlon/Modlncation 0 Other <br />2Y� f9 <-CK/ <br />Doi <br />0 Monitoring Wells) # or wells 0 Soil Boring(s) x d °on"4' 0 Geolachnlcal <br />0 Oul-0f-Service Well 0 Out -Or -Service Well Renewal U Cr066-OonneOt on Repair N RONMEN UN <br />O�lew Pum 0 Pum Re lacement 0 Pum DEPAARTM <br />p <br />h <br />Repair D Raise Well Casi-TM <br />WELL CONSTRUCTION N <br />26� ' <br />Drilling Method D Mud RolerjR. Air Rotary 0 Auger D Cable Tool D Push Point 0 S11her <br />Proposed Well Depth J•L <br />_ Z 9 <br />TYP. <br />Excavation In diameter D Open Bottom Pd Gravel P.0JGravel Size_ <br />in diameter <br />D Conductor Casing in diameter I Conductor Casing Depth <br />G <br />e <br />ft <br />Well Casing Diameter j in Thickness/GaugelASTM Sched�_ D Sleet <br />• <br />Grout Seal Depth /DZ) U Stelnles Slee' ❑ Other171/Al <br />Cement (94 1b beg/5- to gel Weler) <br />Nestand % <br />_ t <br />�.0� C <br />�85antl Cement. <br />a � <br />0 Benlonite (206 solids) ❑Other - sack mlz/7 gel wafer <br />id Otho <br />j <br />�—. <br />Grout Placement Method. Pumped 0 Free Fan n <br />Y ra,,r 0 Pump Contract ❑ <br />ectal DDlmanafons Width g <br />Turbine ❑ Olher _- HP <br />erdOnt /Accelerator (name) 30 7 -�7- 7 - -1440111f/ <br />(5AA 14 C <br />_ ft Thick In 0 Christy Box D Stove Pipe <br />7 / <br />Set ft Blanding Watar Laval n .� %i CL .'rr <br />ameter•eL in Thickness/Gauge/— AS <br />Depth /8 a ft ❑ Neat Cement (94 Ib bag/5-10 gal <br />D Bentonite (20% solids) ❑ Other <br />­ar I /n.i........1 n C..... Cell n /lther <br />ri Rpfarrianf I Arrplpratnr Innmp\ <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />