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4 4 ' <br />X X 4_ rn X <br /> <br />!.7.' <br />11 <br />0 T. <br />g <br />;t7 <br />I I <br />< n1 <br />Z' 47 <br />3 P" i? 111 <br />ii O. in- . 5 a 42'm <br />4, : a . * t a <br />a L_ <br />ol <br />X <br />a <br />-71 <br />‹r- <br />Application Form #1 <br />ottl'"vi,t11 <br />SEP 2 3 1994 <br />APPLICATION FOR WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P 0 BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201-388 <br />(209) 468-3420 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />L7N7,1,-A (Complete I TripHeats) <br />Appli <br />Jv <br />ket100 is here by made to the San Joaquin County for a permit to construct and/or install the work described. This application is <br />made in Compliance with San Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Public Health <br />Services, Environmental Health Division. <br />Job Address/or APN# 110 N. Filbert Street City Stockton A Parcel Size/APN#pprox. 1.0 acre <br />Address <br />Address <br />Address <br />Owner's Name Del Monte Foods <br />Contractor <br /> Gregg Drilling <br />Sub Contractor <br />2716 E. Miner Ave., Stockton Phone #209 -466-9011 <br />Pacheco. CA. Lic# 489165 Phone #510-680-4442 <br />N/A Lic# N/A Phone # N/A N/A <br />TYPE OF WELL/PUMP: M NEW WELL <br />DESTRUCTION <br />11 INSTALLATION <br />REPLACEMENT WELL <br />OUT-OF-SERVICE WELL <br />WELL SYSTEM REPAIR <br />MONITORING WELL # <br />GEOPHYSICAL WELL # <br />CROSS-CONNECT REPAIR <br />0 OTHER <br />SOIL BORING <br />EY VAPOR EXTRACTION WELL #Seebelow <br /> <br />2 borqMs°F (M/SP1 and SVE/SP2) , each boring contains a 2" Air sparging wells/2" Va <br />New 0 Repair H.P. DriTH PUMP SET FT. FIRST WATER LEVEL <br />er4-6.144,es.,,,e4v,r5 <br />ell <br />INTENDED USE <br />I] INDUSTRIAL <br />DOMESTIC/PRIVATE <br />PUBLIC/MUNICIPAL <br />IRRIGATION/AG <br />MONITORING <br />APPROX. DEPTH <br />TYPE OF WELL <br />El OPEN BOTTOM Sand Pack <br />CONSTRUCTION SPECIFICATIONS (Also see attached DriIlling Spec 'cation) <br />DIA. OF WELL EXCAVATION 12" DIA. OF CONDUCTOR CASING <br /> <br />ft) GRAVEL PACK/SIZET,nnstar TYPE OF CASING/STEEL/PV0@5Ch.40PVC* DIA. OF WELL CASING 2" Lttr".5Pg, <br />DRIVEN 2/12 DEPTH OF GROUT SEAL 60" SPECIFICATION - <br />II OTHER GROUT SEAL INSTALLED BY G. Drilling GROUT BRAND NAMENeat cement/Bentonite <br />GROUT SEAL PUMPED: /II Yes 0 No CONCRETE PEDESTAL BY DRILLER: 0 Yes i] No <br />90' LOCKING CHESTER BOX/STOVE PIPE Connected to treatment system <br />MUD ROTARY AIR ROTARY AUGER x CABLE OTHER <br /> *1st 20' sch. 40 Carbon <br />(Hollow—stem) <br /> Steel for Sparging well PROPOSED CONSTRUCTIONIDRILLING METHOD: <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, <br />State Laws, and Rules and Regulations of the San Joaquin County. Home owner or licensed agent's signature certifies the following: "I <br />certify that in the performance of the work for which this permit is issued, I shall not employ persons subject to WORKMAN'S COMPENSATION <br />Laws of California." Contractor's hiring or sub-contracting signature certifies the following: I certify that in the performance <br />of the work for which this permit is issued, I shall employ persons subject to WORKMAN'S COMPENSATION Laws of California." THE APPLICANT <br />MUST CALL 24 HOURS IN ADVANCE FOS ALL REQUIRED INSPECTIONS AT ROAM-3423. Complete drawing at lower area provided. <br />Signed X (A/ Title Project Manager Date 9/21/94 <br /> <br />PLOT PLAN (Draw to Scale) Scale li " to 20' <br /> <br />i. Naffies if si.reets or roads nearest to or bounding the property. 4. location of house sewage disposal system or <br />Outline of the property, giving dimensions and North direction, proposed expansion of sewage disposal systems. <br />Dimensioned outlines and location of all existing and proposed 5. Location of wells within radius of 150 ft. on <br /> <br />structures, including covered areas such as patios, driveways, the property or adjoining property. <br />and walks. Specs on NP1 See Application Form #2 for <br />DEPARTMENT USE ONLY <br />Application Accepted By '777q <br />k2 Grout Inspection By . 1...746; Date <br /> <br />• <br />Date Area <br /> <br />Pump Inspection By Date <br /> <br />Destruction Inspection By Date Comments: <br />ACCOUNTING ONLY: AID# FAO <br />INVOICE PE CODES FEE INFO AMOUNT REMITTED CHECKACASH RECEIVED BY DATE PERMITISERVICE REQUEST NUMBER <br />3 01 -.6)1 '8'1 3.4.tocto- '')/r)- 1(---22--?(-1 004 7 .7 -7 4111WitE— <br />t)kOi:)6L-k 11(10 ---