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1 WELUPUMP PERMIT <br />,9ANJ0AOLnwC IAl. HEA I,INDEPAaT2ilan, 1ILIEAST Himi.-ON AvFA r SIDC,TOkCAl5209 12191466!420 <br />NON-REFUNDAIUE PERMIT CALL <br />---- - _-"-"J 6b1-%69 0" INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />ro.AloOMS 1681 Eai"0fXel.Slreet-- oT,,zrr• Stockton_ <br />/95205_ <br />CROSS STTtEET S A Street APN 153-090_580-000 1 312 aces <br />- <br />_PA"" 3.Zr _ ^ LANDUst A.r,rcAr;oN0 <br />OWNtR NAME United Charter, LLC, Raymonq Zhang Managing Member PKONe (4 15) 2fi9-6r;i i <br />OWNU AODF490 1617 East Main Street - ` <br />GrgzDrilling <br />C:nasTAT[FdP Stockton, CA 95205 <br />TR <br />CDNACTnR _ <br />PNosre 9� (925)313-; <br />CONTRACTORAON"Ill 950 Howe Road �'�I+/� ��«� - <br />- -. c TYrsTATr rz3P �___r_�T Martinez/94553'0 <br />.cols Tont Wallace -Kuhl &Associates (916) 372-1434 <br />SUaCOfr}RAQ'rDRAooaPSe 3050 Industrial Blvd.` ClrrlsTATEJZP West Sacram_ento?CA.'95691, <br />Lice -e ?Cr, 57 G41 D D -W C Other Nur!eErs 72090448515 AAiIOIiDATe 4130124 01/31/2026 <br />DOMISTIC WELL SAAO`Lwa: a General ht-�nIfRUCpllrorm Bacteria (4391) O Dibranoc W0prDpSn0 (4392) p An9urrc 14 393) _ <br />IN7eNDED UeE UPumc Water Sys `1 lrrlgal'oNAgncullural - Industrial D Water QuWrly MONtaMg ](gos s++T+pongrCh+N ,..la,.ls, <br />G Public Water Syslom� _ <br />U ^JRrr•rA tor- Jwnv WAIv �� N�rM _ _ - <br />hM_Q WoRtt t7 New Well Replarrment well WeltAAtteerstbrYMomenev ^ Other — <br />G Monitoring Welllal_. a c' wci s Sod s s to ps <br />n,,ioiSr,cewell Br2r6g(1 iKGeu'eJr;cr 7 edtanEa <br />Out Of Service VM Rainewa' ms r. ar netlbn R, <br />Wti L Ctrmv PumP __ ? P Tc aeplaWI celae l pump Repa+ Ra va WCAJU p <br />DNSTRucno,, <br />Drllllny Method Mud Rotary Air Rala y 3C.Augar cable Tool U Push Point <br />Proposnd Woll [,,@ pit, 15 � �'- <br />ln ft Excavation In diameter 0 Open Boltam G Grave( PackK3rav+N S,rq In �an <br />Conductor Casing in diameter / Ccnductor Casing Depth R <br />Well Casing 1 i+reter _ h ThkAness/Geuge,AStM Schad _ <br />d St" o Plastic Sis mess Steel <br />Grout Soal [)Spin 14 R X.Neat Cement 0941b be T <br />Barites le (20% solids) n Other 0 ge! water) !] Sand Cement a7,; W,pyo wrr <br />GroutPlacomsntMethod U pumped )(Free Fall G Oiher ami It W4 eTT RetardardIAcceilil or(—I NT <br />EGTA L Installed By Driller Pump Conlractoi Olter <br />Concrete Pedestal r Dimensions Width _ R Length _ _ R Thick <br />Christy Box _Stove Pipe CC <br />(PUMP Sclxno,nlWo.� 22 <br />Turbine Other HP r-ranpSet R W'a' U �� <br />Plot Plan Requirements: Attach a plot plan with the exact location of nater well with respect to ojthge fal�vG.t <br />lo 10 ^ N TY <br />f nordinatev, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, e2LstillftEA�Qh <br />pellenlial sources of contamination, sewers or private disposal systems Include diiuncr frim two pruperl} lint+.far Marries NT <br />Agriculture, Industrial well, provide location cram water welts or surface water within 260' radiuv of proposed well. <br />Ili\1�I1 U li Illll It IDs 1\i t \III D t RI UI 1191 D 1011 I\sIR.1 110\S• <br />DEPARTMENT USE ONLY <br />Appical nn Accepted By C L--_ Oale S / 14 / ✓' :�� <br />Growl Inspection By _ Cale �— <br />Pump InsoP-1,nn By _ <br />Soil Boring Inspe uc-iBy _ <br />COMMENTS <br />Cate <br />L)a'fl <br />Area <br />SPECIAL Well Permit <br />WAVER Received <br />COrmlructed Wail Depth _ jt <br />EFina1341 16137021 Py, 1.(2 6,. Fti V r r <br />