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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E. WEBER AVE., STOCKTON CA 95202 (209) 468-3420 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS E 7757 eas 1- I-94/5 1 2- <br />PARCEL SIZE/APN A/15.3 c. / CITY/ZIP V i'c-hr 9 5 - 2- 5- 3 / <br />propex- bp <br />OWNER NA <br />i <br />ME W I' t 4 kose, Vi've.yvtd4 ADDRESS P • 0 • o y 2 q 8 <br />CITY/ZIP V ici-or, , q 5 2-53 PHONE 101 - 3 3 cl - 0 I 01 <br />CONTRACTOR Specirurm EX10( orc-tic?‘ ;Inc- • ADDRESS 22) Co 5 tikb1/4.. b•J Arm Drive. <br />CITY/ZIP ShCAC-firrl C A q 5 2- 0 5- PHONE 2_e? - Ii(p5--C-C\X '-/h2 1 <br />GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP 3 RANGE 7 SECTION Lt fil 'DB frt <br />TYPE OF WELL: 0 NEW WELL 0 REPLACEMENT WELL 0 MONITORING WELL # )16 OTHER SD I ' ( 6C1ri 1153 <br />INSTALLATIO <br />b <br />N: 0 WELL SYSTEM REPAIR 0 CROSS-CONNECT REPAIR 0 VAPOR EXTRACTION WELL # AI <br />TYPE OF OF PUMP: 0 NEW 0 REPAIR H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL <br />NM <br />0 OUT-OF-SERVICE WELL 0 GEOTECHNICAL # SOIL BORING 2- '&0 2-0-a-- 0 DESTRUCTION: <br />a <br />INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION 0/ A. <br />0 INDUSTRIAL 0 OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA ( <br />0 DOMESTIC PRIVATE 0 GRAVEL PACK/SIZE WELL CASING TYPE WELL CASING DIA <br />0 PUBLIC/MUNICIPAL 0 DRIVEN GROUT SEAL DEPTH ?-0 fe SPECIFICATION e 1,4-04ei5 Kg- <br />0 IRRIGATION/AG OTHER GROUT BRAND NAME <br />,.4-ifeossi Etc • 0-41,e/r vr <br />%MONITORING ft (3113( 004 Mnre: te.r‘ •gOil .Ca-vvp./0- GROUT SEAL PUMPED: kai Yt.S Ori NO5 VAAJ1 <br />0 .CHRISTY BOX 0 STOVE PIPE CONCRETE PEDESTAL BY DRILLER: 0 YES 0 NO , <br />APPROXIMATE WELL DEPTH 2o fecE kloo fAA.e, .--,1 ‹ 8--all*,.,e 1-11, viott <br />PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER X .5414)16411-4 <br />Violl.00 l/l '6/00 <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN - <br />JOAQUIN COUNTY ORDIANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED: VId&A/a C • AO <br />TITLE: Se114.4/ eptraixd-frAdj 'eet-frif-y,cet A ace, DATE: 3/6/1-6e20 <br />/11,( <br />DEPARTMENT USE ONLY <br />Application Accepted By CAAAAA/flat 1-) Date 3(1 3/b Area <br />Grout Inspection By t/ iCNAAA.A e i,---.. Date ump Inspected By Date <br />Destruction Inspection By Date <br />COMMENTS: <br />PE <br />CODES <br />SC <br />INFO <br />AMOUNT <br />REMITTED <br />CHECK#/ <br />CASH <br />RECEIVED <br />BY <br />DATE PERMIT/SERVICE REQUEST # WELL ID# <br />3 5-01 VI • ° ° 17-3 2, Gt2 3b 3 leo 0 0