Laserfiche WebLink
4 <br /> g3JELLJPUMP PERMIT <br /> SAN jOAQUIN COUNT`.':WIRONi3EN7AL HEALTH EEPAR=Em-i 1868 EAST HAZELTON AVENUEON CA 95205-0209)46&7A20 <br /> 0N%-REFUtdc?:i _EPEFC•:i; CALL(209)5a3-7a'9i=-3RivSFIECT;ONS EXP1RES IYEAR FPXK-DA:cISSL'E <br /> I L t r1��P ('`\c� crrcnla 1 ro_c T30 L! ---I1 I> <br /> j05 ADDRESS } t o <br /> fCROSS'STRPET -D C 1 t1-1 0- T_S APIZ Z 3� ' .�.--1 U- I PARCEL SLE S V•3 LAND USE APPLIGl t10Tt I -'fin <br /> tI ,, 1' s 7-t>9 3uo t ILL <br /> C1JIN�3:JADE '�.Q � 1 <br /> �OV,-!ER:A13DFZESS �D�� j-'"✓� l'7 C)( 1 { r - C17YisTATEIZI I r�OL`eS �O C/T Q S31 p <br /> (CONTRACTOR <br /> Maggiora Bros.Drilling Inc. �Na�E 831 7241336 <br /> CONTPACTOR ADORES✓ <br /> 595 Airport Blvd. 0r1X1S7ATEra Watsonville,Ca 95076 <br /> PHONe <br /> SUSCONTRP.CTCR - <br /> ^,iY/STAT'JP-? <br /> 'SUBCom-,RA--.OR AOMESS S - <br /> iir57y� '%61 DW Other ;itmt�R �. dq�Q�-7E..nunoNJATE X70-,6 1 ; <br /> JCE�IS-c '' <br /> 1 T Cl-as p_ Range .S7ec30,__ <br /> C-EOGRAPi'iICALiNPORMATION: C007dirratas <br /> I Fvr-NDED USE DomestidPrivate a.inigz5on/Agricu5ural Industrial ''Vater Ouaey Monitoring Soil Samolvrg/Characterization <br /> PuhlicWater 19 stema m,1 n m <br /> rc e;f—A nom 010_ rmm. Pte <br /> T:JE QF 44.OR:C 01lew Well Replacement Well `.Nell AlteretionfModilication of twn ether of tcn,ss <br /> Monitoring Well(s) t#of walls 30ii Boring(s) Geoted-4kal <br /> ,Dut-OfService Well -Tut-OfService Well Renewal -ross-Connection Repair <br /> -JewPump Pum Re lacement lump Repair :2aise Well Casing <br /> YELL Coma--iOrnlI <br /> �Dr[lirx rrie+.cd )(Mud Rota✓+,, air Rotary Auger .able Tool Push Point Other o f�/h ' ZSDy <br /> ," <br /> lf, Excavation in dramela Dpen Bottom •�ra>(el PacJG aver Size _in diameter <br /> a ) <br /> r�os:�L':elf Depth_ �- I <br /> -conductor Casing '�,(o in diameter I Conductor Casing Depth `t <br /> !Neil Casfac Diameter !n ThicicnesslGaugelASTilh Sched I _ Steel Plastic ilaint^SS Steel Other <br /> Gree[Seal Depth � ft 'Teat Cement(g4'Ib bao/b-10 921 water) Mand Cement ) sack rrtk, gal r.2:erl <br /> Bentonite(201/6 soads) Dther <br /> Retarded I Ac c!iera:or(.alnr) 1 <br /> ,Grout P'acemer` ztfio� ?um Free Fail Jiher I <br /> PEDESTAL 17ssi.ed B; Driller Pump Contractor Other r,. <br /> Ccn ra^a Pades°zi Dir aslorts Width r1 Length ft Thio" in ay 3cz 54cre?fIx 1 <br /> ?taaP Submersible Turoine HP Pump Sri ft Star> tng vvates Lev2J f <br /> I HEREBY.^E,ZT:FY T:iAT 1 :-iAVE FRE APED TH--S APPLICA71ON ANi WOW THE OW WILL BE DONE- ACCORDANCE?�- <br /> • i SAN <br /> JOAOIF.N COUfJ7Y OR,7f;t1ANCS,STATE �iPJS, ;WD RULES AP,T. REG(A_ T+Of� ! ALSO 0'12:1:-7 Tt•1.'S-3`1'REC•i7t=_L'EiiS'e tS <br /> CJRREh,X-1 ACTIVE§ViT;a THE CAA-'FOR71AA 1_0f'79-A--TCRS STA'E L1Cc1q5E So-'RD slVP.TF'.A rkll Sid CCI9PLV MC_ <br /> 'HG2PS w;�'PE!l'S.".TiCN <br /> LAWS. <br /> rr:iL�i":1li? <br /> 2S ]C 3. k = TICE FOR'HSPEL 1 01dS-P`_EA.S=CALL(2,09)p953-:6S7 <br /> SIGr� TmE C7LJ�ne/ DATE <br /> II I II <br /> R g YMF <br /> I <br /> I ! i ! <br /> EcC <br /> I O <br /> FP <br /> 09 <br /> ?o?1 <br /> RpU/NC <br /> D pq� NTY <br /> NT <br /> L I <br /> DEPARTMENT USE ONLY <br /> / n <br /> Application Accepted By v Date / 7 di Area ez �: Employee ID#� <br /> Grout Inspection By b Date 4--:` Ll SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS 7D5 3 - 2 - 3 °► rrf7 <br /> PE SC Received kSChec Amount Date I PermW Invoice# Well ID# <br /> Codes Info as Remitted Service Re eget# <br /> tip; <br /> WELL#PUMP PERMR <br /> E1043-06 6/118015 <br />