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arymp Lathrop, 95330 JOB ADDRESS 700 D'Arcy Parkway <br />PARCEL SIZE 19 a CLAND USE APPLICATION* N/A CROSS STREET Murphy Parkway APN 196-220-02 <br />LICENSE X 12-57 C-61 D-09 <br />BILLING PARTY: OWNER <br />7/31/2022 <br />EXPIRAnON DATE <br />954267 <br />Other NUMBER <br />CONTRACTOR K SUBCONTRACTOR/CONSULTANT <br />TYPE OF WORK New Well Replacement Well <br />Monitoring Welt(s) A of wells <br />Out-Of-Service Well <br />DPool <br />Well Alteration/Modification Other <br />Of b oorings PP of bonngs Soil Bonng(s) N X Geotechnical 10 <br />Out-Of-Service Well Renewal Cross-Connection Repair <br />Prrnw Repar r Raise Well Casino <br />/2q7/0,3 <br />/PUMP PEPfer <br />EHO 43-06 bill/20i9 <br />/to Employee ID# A <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAzELToN AVENUE -STOCKTON CA 95205 -6232 (209)468-3420 <br />NON-REFUNDABLE PERMIT www.s"• ov.or. /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESnC WELL SAMPUNG: General Mineral/Coliform Bacteria (4391) fi Dibromochloropropane (4392) Arsenic (4393) <br />Soil Sampling/Characterization iwrENDE D USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring <br />Public Water System <br />Water System Name If different horn Owner Contact Name or Phone Number <br />I HEREBY CERTIFY THAT I 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 UCENSE IS <br />CURRENT AND ACTIVE WITH THE CAL RNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIM <br />SIGNED <br />SEE ATTACHED <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />Bx., <br />Check#/ <br />Cash <br />Amount <br />Remitted Date <br />Permit/ <br />Service Re uest # <br />Invoice # Well 113# <br />2.4 ,../11 /IA I.AI-VOL11vc- <br />_ <br />TICEREQUIREDFORINSPECTIONS-PLEASECALLP09053-7697 <br /> TITLE 111.AZekr. F.4*%y"Nee—r DATE 6/ ic /IA <br />(# <br /># <br />Area <br />Constructed Well Depth <br />)4(71 <br />DEPARTMENT USE ONLY <br />Date <br />Date <br />Date <br />Date ft <br />SPECIAL Well Permit <br />WAIVER Received <br />OWNER NAME Teals Motors <br />OWNER ADDRESS 47700 Kato Road <br />CONTRACTOR ENGEO <br />CONTRACTOR ADDRESS 17278 Golden Valley Pkwy <br />SUBCONTRACTOR/CONSULTANT Geo -Ex <br />SUBCONTRACTOR/CONSULTANT ADDRESS 1510 Madera Drive <br />PHONE ( 510) 452-7124 <br />cirosTArErzip Fremont, CA 94538 <br />PHONE (209) 835-0610 <br />CITY/STATE/ZIP Lathrop, CA 95330 <br />PHONE (916) 799-8198 <br />crrylsiAmizip DiXon , CA 95620