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si mod x <br />I <br />JAN-30-1996 14:40 FRO r ':ENOIRONMENTAL AUDIT. INC TO 35123212094683473 P.03 _ <br />ENVIRONMENTAL REALTH DIVISION <br />P 0 BOX 3118. 445 4. SAN JaAct0IN Z. STOCKTON, CA sszni-aag <br />I211.91 463-3420 <br />001140FIXDASUEPERAITT WIRES 1 YEAR FROM DATEISSUED <br />nba45440 Trig=I WI <br />AmOticatiOn is here by made to the $an Joaquin Gar.:1, for a permit to construct and/or install the or described. This application is <br />m'ade in compliance with San jobwin Coway OevelcMent Titk -:. Chapter 9-1115.3 and the standards of San Joaquin Cor-rity Puttic Health <br />services, Environmental Health Division. <br />Joia Address/or APAls 5400 Pacific Avenue City Stockton Parcel SiZe/APbtati 4 <br />cuner.,x„ Mont. Ward & Co, Inc. ,l4re$4 1331 S— Harbor 1:11vd Pilllertica <br />c=nroctorEnvironmental Audit. Inc. Acidress1006-,A nr-b=ga 606348 <br />Sue. ContractorY & W_Drilling Aqdressprw 51, Rio Vista. CA L1ci658786 <br />Phone 171 4-723-6227 <br />p}, *714-632-8521 <br />F'horiet *916-631-7165 <br />tYpt. OF WELL/PVHP: Yi MEW WELL <br />DESTRUCTIC* <br />)f INSTALLATION <br />New 0 Repeir <br />2.E.AOL4EAT UELL MOMIYORING WILL t 8 <br />CUT-OF-SERVICE WELL 0 GEOPHYSICAL wILL <br />Wal SYSTEM REPAIR 0 CROSS-CtaiXECT REPAIR <br />K.P. DEPTH PlImP SET FT. <br />13 OTHER <br />'0 SOIL BORING <br />VAPOR,ENTRACTION :ELL I <br />FIRST WATER LEVEL <br /> <br />(TYPf OF PUMP) <br /> <br />CONSTRUCTION SPECIFICATIONS <br />11 <br />DIA. OF 'LL EYCAVATICN DIA. OF CONDUCTOR CASING NA <br />TYPE OF CASING/STEEL s61 an DR. OF WELL CASING 4" ID _ <br />SPECIFICATION <br />GRCUTSZi. INSTALLED sy V & W IZ1llicacur ERPSD w+EPortla n <br />CRCUT SEAL PUPPED: 2: Yes 0 No CONCRETE PEDESTAL $Y DRILLER: 0 Tea C X0 <br />APPRDILDEPTH <br />PROPOSED CONSTRUCTIONTORMING NITHOO: RCITA -Z AIR ROTARY AUGER X CASLE OTNEO <br />merrty certify Inat I hare prepered this 3p:4:c2non and that the werk will be done in accerdbnce With San Joaquin C.ounry Creinancls,' <br />State Laws, and Rules and Regulation= of the San Joaquin Cocrity. Home owner or licensed agent's signature certifies the fetlewirg: "I <br />certify that in the perionmanct of the work fori.nich this permit is issued. I shall not eimakoy persons subject:toWORKWAN'S C=4P5/SATICH: <br />Laws of California." Contractor's hirirg or rug-contracting signature certifies the foitowing: ' I certify that in the perioresnce <br />of the work for which this permit is issued, ! employ persons su63ecr. to uORKHAN'S C^J.1PENSATION Lai.s of California." THEAFTLIO.'AN'T <br />HOST CALL24 ffi&6 U 1UO ILSFECTIONS ATI201140-3423. Complete drawing a: Lower .area provided. <br />TitteSenior Project Geologi.st D 4 te1-30796 <br />I I <br />r <br />amps) USE <br />INDUSTRIAL <br />DoKESTIC/PRIVAIE <br />PO/JUG/MUNICIPAL <br />IRRIGATION/AG <br />D5 MONITORING <br />70 <br />TYPE oFvvrta <br />OPEN SOTTO* <br />NI GRAVEL PACX/SIZI <br />DRIVEN <br />OTHER <br />DEPTH OF GRCUT sf..ALA rox. 48 <br />LOCXIMG CHESTER NON/STOVE PIPE <br />Brent Mecham . <br />DEPANYMEXT USE ONLY <br />Application Accepted Sy Date <br />Grout Inspection Sy Date Puma Inspection SY <br /> Date <br />Destruction Inspect on ty Date Cccroients: <br />Area <br />A= Dan AID: FAO* <br />s , <br />RECETYEI SY DATE PESJAITISERV= REOUEST NUIIEEit INVOICE I PE CODES FrE Ivo ANDUNT REMITTED CXEC=CASH <br />.. <br />350 I NA) 3543. 00 I 3 2- X _1 4 _ /-34-rt ,ea 3Th?2__1. <br />i <br />1— -7r------)7-1->z <br />) <br />_....._ <br />Se' 'V • ma' • • • So,*