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' WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205.6232 (209) 468-3420 Mr1M_DCCnunAtm C DCONIIT —, .1— —I.hri r=YDIDFR 1 VIZAR FROM DATE ISSUED I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. E ENT 152022 MFNTUNTy 1q R T MENT DEPARTMENT USE ONLY ,7 [ �` % Application Accepted By /"-' I� Date ALS/j,-2 Area v/ Employee ID# I to N `. Grout Inspection By Datei_I SPECIAL Well Permit Pump Inspection By Date 7 Z'C fl WAIVER Received Soil Boring Ins 'on By Date Constructed Well Depth ft COMMENTS 1meri rewrellan 8 MMMF-15-1111=�WAmount L'� v JOB ADDRESS 8129 N Podesta Ln Clrv2lPLinden, CA 95236 m T CROSS STREET St Rt Hwy 26 APN 0� 6} 7 0 8 0 0 6 0 LAND USE APPLICATION # SIZE 5�1- _PARCEL f OWNER NAME Podesta BIOS PHONE u OWNER ADDRESS 8000 Podesta Ln CrrYlSfATFJLPLi nden CA 95236 CONTRACTOR Purviance Drillers, INC PHoNE209-887-3554 CONTRACTOR ADDRESS P-0- BOX 64 Cm/srATEOPLinden CA 95236 SUBCONTRACTORICONSULTANT PHONE SUBCONTRACTOWCONSULTANT ADDRESS CITY/STATE/ZIP LICENSE k C-57 C-61 :: D-09 Other NUMBER 377923 ExPIRATIDN DATE 7/31/23 BILLING PARTY: ':1 OWNER �: CONTRACTOR :.: SUBCONTRACTOR/CONSULTANT DOMESTIC WELL SAMPLING: i7 General MinerallColiform Bacteria (4391) I i Dibromochloropropane (4392) 0 Arsenic (4393) INTENDED USE ! Domestic/Pdvate-lnigaUon/Agricultural ❑ Industrial ^_ Water Quality Monitoring '-!Soil Sampling/Characterization C Public Water Systerr If different from Owner. Water System Name Contact Name or Phone Number TYPE OF WORK _i New Well C Replacement Well E Well Alteration/Modification L Other Monitoring Well(s) # of wells C Soil Boring(s) # of borings F] Geotechnicai # of boring Out-Of-Service ell :1 Out-OfService Well Renewal C Cross -Connection Repair SA New Pum Pum Replacement C Pum Repair C Raise Well Casing WELL CONSTRUCTION Drilling Method Mud Rotary G Air Rotary ❑Auger ';: Cable Tool Push Point Other Proposed Well Depth ft Excavation in diameter 1 Open Bottom C Gravel Pack/Gravel Size :41 Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter_in Thickness/Gauge/ASTMSched :!Steel [:Plastic 11 Stainless Steel ❑Other Grout Seal Depth ft I Neat Cement (94 Ib bay/5-10 gal water) C Sand Cement sack miX L Bentonite (20% solids) 0 Other Grout Placement Method ❑ Pumped _; Free Fall U Other ❑ Retardant I Accelerator (name) PEDESTAL Installed By :; Driller C Pump Contractor C Other Concrete Pedestal Dimensions: Width ft Length It Thick in Christy Box f1 Stove Pipe PUMP Submersible:] Turbine 0 Other HP Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. E ENT 152022 MFNTUNTy 1q R T MENT DEPARTMENT USE ONLY ,7 [ �` % Application Accepted By /"-' I� Date ALS/j,-2 Area v/ Employee ID# I to N `. Grout Inspection By Datei_I SPECIAL Well Permit Pump Inspection By Date 7 Z'C fl WAIVER Received Soil Boring Ins 'on By Date Constructed Well Depth ft COMMENTS 1meri rewrellan 8 MMMF-15-1111=�WAmount L'� •►J%li,�I/��E��L�'i[L�1>jl!i�'�'l1I1�1L'�i� Remittedr EHD 43-M 811112019 W-4 135-662-493 WELL /PUMP PERMIT