My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
WP0041718
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
M
>
MOORE
>
16133
>
4200/4300 - Liquid Waste/Water Well Permits
>
WP0041718
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/12/2022 4:32:05 PM
Creation date
10/12/2022 4:22:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041718
PE
4366
STREET_NUMBER
16133
Direction
N
STREET_NAME
MOORE
STREET_TYPE
RD
City
LODI
Zip
95242-
APN
02702016
ENTERED_DATE
2/19/2021 12:00:00 AM
SITE_LOCATION
16133 N MOORE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
11
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
D <br />v <br />0 <br />1 <br />G) <br />O <br />0 <br />Q - <br />CD <br />3 <br />;a <br />M <br />om`' <br />1 <br />.toe ADDRE"CTTTZP .1, C2if / , <br />CROSS STREET ��rf'A�APN 0 a JJ��_PAgCEL $RL +47- LAND UEEEAAP)P ATION{ <br />OWNER NAME PNONE I�Z�6�T� / <br />OWN ER ADDRESS�S•/� � /// CITY/STATE2IP <br />CONTRACTOR x" ar-^ r �jt1�L �Mr PHONE 3�Y�47Lf <br />CONTRACTOR ADDRESS b N .// -7, .�/A/7 <br />CmISTATEZk <br />P "16±0 Ar <br />SUBCONTRACTORICONSULTANT led" � C.2ar • /'ry��r r PNONE,T'=�7 <br />SUBCONTRACTORICONSULTANT AoORESS CITY/STATEJZIP <br />LICENSE ileC-67 O C-61 O 0.09 D. /Other NUMBER -:': 73Cs E-RATIDII DATE I<—Z! <br />BILLNIG PARTY: DOWNER AONTIIACTOR fl SUBCONTRACTORICONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391)yii Dibiomochloropropane (4392) O Arsenic (4393) <br />INTEHDEOU&E >C-Domeslic'P(roate O 4rigalionlAgricullural O Industrial D Water Ouality MOniloring CI Soil SamplinyCharacter¢ation <br />O Public Water System <br />X elRl 11mrn 0— Wet. S,,,— Nile Cmbd Nafnl M Ph— lWrrber <br />•T TYPE OF WORK PA- Wen O Replacement Well O Well AlteretroM+todification O Other <br />p Monitoring Wen(s) Aof Wells O Soil Boring(s) ""n"' O Geotechnical R t^ <br />D Out-0I-Se1ice Well O Out-Of-Se,iCe Well Renewal C Cross -Connection Repair <br />VELL CONSTRUCTION Mly <br />JMOUI <br />]d9tng Method ❑Mud Rotary G Air Rotary D Auger D Cebk Tool O Push Point n Other <br />Proposed Well Depth-�di2 R E—Vatlnn h- in diameter D Open Bottom ,'>c%rrIvel P&cWGravel U teeter <br />7 Conductor Casing in diameter f Conductor Casing Depth R <br />we Casing DiamelSr-C m ThNl ness/GBuge/ASTM S0ed-2p O Steel jWPI.sliC D Stainless Steel O Other <br />Grout Seal Depth ICE) It O Neat Cement (9410150915-10 gel wafeh JtSand Cement 0%2 sacA mix17 gal water <br />G 9entonile (20%"odds) 0011,11 <br />G cut Placemencut Placement Method, meed O Free Fag O ether O Relardent / Accelerelor lneme) ICJ Free Fan O Other C1 Retardant / Accelerator lneme) <br />�PEOESTAL - Installed By yreDAller :J Pump ContraCor D Other- Installed By ;4cDAller C Pump ContraCor D Other <br />U Concrete Pedestal ]Dimensions Width �_ft Length it Thmi, In O Chrlsry Box O Stove Pipe <br />�PwP b rsibkn Turbine C OtherHP 2e Pump Set R Standing Wafer Level R <br />I err cecTsro NA�•�'sA'�ie=tnvVS.•'A"No •vl'�J('IID ANDr�fAT I Ai�4�1�� ALL <br />3DAQUIM COUNTY SE BOARD AND THAT 1 AM IN COMPLIANCE VAIN ALL <br />CUWORKERSTAND ACTIVE <br />COMPENSATWITH <br />�WSE CALIFORNIA CONTRACTORS STATE <br />MINIMUMM�HO�R A➢VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL D (20) 95fl <br />G TITLE��� <br />�7 <br />:. '7' <br />6/a�lCl E <br />4t-/ <br />4. <br />/`77`Z01 - <br />z 0 z0 <br />Z 16- <br />2- l - <br />6 <br />_ . ...- . _. _ .. n L , ��(Employee IDR. ✓ ^�._ <br />Date .,i.I Alee - <br />AippucaRon Ac2dad B1' Grout Dale SpECIAL WO1I Permit <br />u <br />Gut yypdien PBy WAIVER ReCeNad <br />p,, hoped- By Dale I l W <br />Dal! —� CoilslNoled Well Depth <br />Sa S nN mwCttan W R <br />COMMENTS <br />w"ll too <br />VE SIC d <br />R6.1ft.1 nil to <br />®ni_T-��► <br />`' fir' <br />0 6/ 2 9 1 2022 <br />0 v <br />3 c'—n Q- <br />3 " cD <br />co cn <br />Z3 c-- <br />F-1 <br />
The URL can be used to link to this page
Your browser does not support the video tag.