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1 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />16657 E Milton Rd Linden, CA 95236 JOB ADDRESS CITY/ZIP <br />Duncan Rd APN /O5— /10 — 0/ 0 CROSS STREET PARCEL SIZE LAW:LUSE APPLICATION # , <br />Eilers Ranch, LLC / -,/ <br />/ <br />71 ,r, () - ../ , ' el OWNER NAME PHONE i <br />PO Box 1048 Linden, CA 9 2 36 <br />OWNER ADDRESS CITY/STATE/ZIP <br />CONTRACTOR Purviance Drillers, Inc PHoNE209-887---3554 <br />PO Box 64 Linden, CA 95236 CONTRACTOR ADDRESS Crry/STATFJZip <br />SUBCONTRACTOR n/a PHONE <br />SUBCONTRACTOR ADDRESS Crry/STATEJZip <br />LICENSE yA7C-57 0 C-61 0 D-09 0 Other NUMBER 377923 EXPIRATION DATE 7/31 /2 3 <br />DOMESTIC WELL SAMPLING: = General Mineral/Conform Bacteria (4391) — Dibromochloropropane (4392)11 Arsenic (4393) <br />INTENDED USE 0 Domestic/Private X Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />0 Public Water System <br />If different from Owner Water System Name Contact Name or Phone Numb .1 y fLI A ,, i <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other ! 1 11,/t..' <br />'2 Monitoring Well(s) # of wells 0 Soil Boring(s) # of borings 0 Geotechnical # of bo ngs <br />O Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br />O New Pump 0 Pump Replacement Pump Repair el7F/UP a Raise Well Casing_ SA N_ i, <br />2 8 2022 _?)( <br />WELL CONSTRUCTION E.I0jhlQU/N , i j-i ii /RoN Co u <br />Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Other LIHD iviSA! 7- N r? . <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size '' TripAppmeter <br />C Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in Thickness/GaugeJASTM Sched 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br />Grout Seal Depth ft 0 Neat Cement (94 lb bag/5-10 gal water) 0 Sand Cement sack mix/7 gal water <br />0 Bentonite (20% solids) 0 Other <br />Grout Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />0 Concrete Pedestal 0 Dimensions: Width ft Length ft Thick <br />in 0 Christy Box 0 Stove Pipe <br />.4•ST <br />PUMP 0 Submersible Turbine 0 Other HP /25/0 Pump Set_s2W ft Standing Water Level /4,e, ft <br />Plot Plan Requirements: Attach, a plot plan with the exact location of water well with respect to the following items: CPS <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />DEPARTMENT U E NLY <br />f 9' 7;7 z2—lib ? ft / 5 Application Accepted By ,44...r., Date Area Employee ID# <br />Grout Inspection By ...11.1. 1.1.;011 -Pi— Date , 0 SPECIAL Well Permit , miiffii.--_,, <br />Pump Inspection By Illi/I Date 4, 0/ 197(2 0 WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Checi4/ <br />Cash <br />Amount <br />Remitted Date Invoice Permit/ <br />Service Request # # Well ID# <br />t/32. aso J 0 5a— 77 1/2-3/22.- I WP004-3'353 <br />EH0043-06 101512021 <br />&_,64 is-6s,032 se: " <br /> <br />Well I Pump Pcmii