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005sw <br />APR 1 2 1999 <br />APPLICATION FOR WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 <br />NOMREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />(Complete In TrOlken) <br />APPLICATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORE DESCRIBED. THIS APPLICATIONISMADE IN COMPLIANCE WITH SAN <br />JOAQUIN COUNTY DEVELOPMENT TITLE. CHAPTER 9-1 1 1 5.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. <br />JOB ADDRESS/OR API41/ 2427 West Yosemite Avenue cm, Manteca PARCEL SIZE/APNO <br /> 1981.06acreE. <br />OWNER'S NAME ABF Freight System, Inc. ADDRESS P.O. Box 10048, Ft-Smit.ITHONE 1 (501)7858700 <br />CONTRACTOR CAL INC AmmE8,2040 Peabody Rd -2%657754 PHONE k 707)446799E <br />SUB CONTRACTOR Bay Area Exploration, Inc. ADDRESS Vacaville CAucs522125 moNE800 622DRIL 459.i Central_ one ia, CA <br />REPLACEMENT WELL <br />WELL SYSTEM REPAIR <br /> <br />O CROSS-CONNECT REPAIR <br />H.P. DEPTH PUMP SET FT. <br />OUT-OF-SERVICE WELL 0 GEOPHYSICAL VVELL <br />g-f <br />VAPOR EXTRACTION WELL <br />FIRST WATER LEVEL 0 <br />SOIL BORING 8 <br />TYPE OF WELL/PUMP; 0 NEW WELL <br />o INSTALLATION <br /> 0 New 0 Repair <br />(TYPE OF PUMP) <br />Or MONITOR/NO WELL S 3 0 OTHER <br />al DE8TRUCTION:13 roposed: pressure grout sealing of 3 monit_o_ring wp11s, MW -1, -2 g, -3 <br />0 DOMESTIC/PRIVATE 0 GRAVEL PACK/SIZE TYPE OF CASING/STEEL/PVC DIA. OF WELL CASING 0 <br />PUBLIC/MUNICIPAL 0 DRIVEN DEPTH OF GROUT SEAL SPECIFICATION R 5`) <br />0 IRRIGATION/AO 0 OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME E <br />0 INDUSTRIAL 0 OPEN BOTTOM DIA. OF WELL EXCAVATION DIA. OF CONDUCTOR CASING 0 _r <br />INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A (3-) <br />-.1 <br />MONITORING GROUT SEAL PUMPED: 0 Yee 0 No CONCRETE PEDESTAL BY DRILLER: 0 You 0 No S <br />APPROX. DEPTH LOCKING CHESTER BOX/STOVE PIPE S <br />PROPOSED CONSTRUCTION(DRILUNG METHOD: MUD ROTARY AIR ROTARY AUGER CABLE <br />OTHER <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND <br />See attached monitoring well logs for dptails of wp11 _nnnstruction <br />REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR UCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WON( FOR WHICH 3 <br />THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALWORN1A.' CONTRACTOR'S HIRING OR SUS-CONTRACTING SIGNATURE CERTIFIES <br />THE FOLLOWING: I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHAU. EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF S34 <br />CAUFORNIA.' THE APPUCANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REGUIRED INSPECTIONS AT 12001408.3423. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br />Stoned X Title Of e4:41' cyA <br />Des q C ?? <br />nor PLAN IDrsw to Saes) Sees 1 i ja • to so ft <br />I. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />OUTLINE OF THE PROPERTY. GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED <br />S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br />STRUCTURES. INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br />Please see attached plan map. <br />• <br />DEPARTMENT USE ONLY <br />AppliciAm Aattepted By 62f1A 4Ac--4"—. Dee C <br /> <br />1cl <br />Arse <br />Grout Inspection By (I Dote <br />Beetructlen IneneetIon By /1/d>( <br />Commeryte.7l,rCarVAil.) fr-.4,:k ) <br />Purnp Inspection By Dots <br />7. r <br />ACCOUNTING ONLY: AIDS FACE (7 / 6 R (2(7, I <br />PE CODES FEE INFO AMOUNT REMITTED CHECKS/CASH RECEIVED BY INVOICE DAT 's.---RrM/EET-RW----------- PERMIT/SERVICE BIM <br />3co I i t,o. Do 1131-32-- (AL <br />Pub Health Serv. - Enviro. 173 (1/97)