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• <br />-.4-4 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 / ii-S-4) t VA eserf4 t - frZ 1 te 64101 ?INN( <br />ce <br />W \E\rEIC\ Be <br />PARCEL SIZE/APN I q-S---//C.PC4/0 i'q -080 -0/ CITY/ZIP S'as, Tc•ii A.,' ..1 t <br />OWNER NAMIegrtiELe SttM'1, flvJ/tCIADDRESS Pi O. /So IC MO C.001\1" \i\cEs ps 30 ND.A s.vk \liso CITY/ZIP 5 tv c-i< f w-Pc PHONE 2 0 aft -4 Y/—/ rb6 s <br />°I l* Pl0-1('' <br />CONTRACTOR 6-1" eiffr 17,,,1 I , i- in N r*,,,,ADDREss q.1-0 Ho t.4..- e !Vaal S 0\1\1\010" <br />t kikno" <br />7 <br />CITY/ZIP mas.time Z. giY -1—r-S PHONE Cra 5----• 7 / 7 - -1— ta 0 0 <br />GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br />TYPE OF WELL: 0 NEW WELL 0 REPLACEMENT WELL 0 MONITORING WELL # MI OTHER S14 t eCI 04/131 <br />INSTALLATION: 0 WELL SYSTEM REPAIR 0 CROSS-CONNECT REPAIR 0 VAPOR EXTRACTION WELL # <br />TYPE OF PUMP: 0 NEW 0 REPAIR H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL <br />0 OUT-OF-SERVICE WELL 0 GEOTECHNICAL # jz SOIL BORING ta 0 DESTRUCTION: <br />INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br />0 INDUSTRIAL 0 OPEN BOTTOM WELL EXCAVATION DIA47fri ge CONDUCTOR CASING DIA <br />0 DOMESTIC PRIVATE 0 GRAVEL PACK/SIZE WELL CASING TYPE WELL CASING DIA <br />0 PUBLIC/MUNICIPAL Lii( DRIVEN GROUT SEAL DEPTH SPECIFICATION <br />0 IRRIGATION/AG OTHER GROUT BRAND NAME 24 HR NICYTICE <br />MONITORING R EC) U ESTE_ ID GROUT SEAL PUMPED: 0 YES 0 NO <br />FC) R ,A, I_ 1_. CHRISTY BOX 0 STOVE PIPE CONCRETE PEDESTAL BY DRILLER: 0 YES 0 NO <br />,mINISPEc,--r-icitNis <br />APPROXIMATE WELL DEPTH Tioutv• 6 leer dayo, 6- .A.r- 7.- kea- 444re • <br />PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER Oia•ealqa 4 <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN i <br />JOAQUIN COUNTY ORDIANCES, STATE LAWS, AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED: de- 0 ,c...004-4-02- <br />TITLE: eif V; e's&-/ r."44,AW is ea +fir-Alio% DATE: /71/D° 4, <br />MW-2 <br />S <br />. MONITOR WELL. <br />4, <br />0 ? <br />0 PROPOSED SHALLOW BORING LOCATION <br />0 PROPOSED DEEP BORING LOCATION <br />‘1‘," CONCRETE 4. k A PROPOSED SIMULPROBE BORING LOCATION <br />j 4i' 0 RETAINING <br />• 4*(3 WALL <br />11•., -2' C3 FORMER <br />(2- 4. ci USTs <br />4" <br />32 <br />. 0 <br />"P 0 1 4, 4, MW-3 0 A „. ,....4_, MW — 4 ,p4.0 <br />0 A 1/4 i <br />. AGRICULTURAL FIELD <br />MW-2 FERRY <br />RAMP 0 & <br />DRAINAGE <br />& DiTCH <br />IV % EIGHT MILE ROAD! i ' Nf 4. <br />i I <br />1 , <br />i .§.- <br />Application <br />El PuilP <br />PUMP PIPING TO SLOUGH I! HouSE ISLAND DRAINAGE <br />WALKWAY <br />Accepted By Date <br />CHAtili n 50 ,/ eto <br />I I Area 77 Cli <br />Grout Inspection By Date Pump Inspected By Date .i <br />Destruction Inspection By Date <br />COMMENTS: AkS beeii piathi ,Av e, gouit t.y. 41k14 n r-0.9(.4 . wcegki -t,--ivv--=- <br />1 0 ox icAlla 0 I <br />r J 6453,,,,, .0._ ei r Le-e 1 ,j22 inytv 'Liu b v. siotte pevveize . <br />PE <br />CODES <br />SC <br />INFO <br />AMOUNT <br />REMITTED <br />eHECK#/ RECEIVED <br />BY <br />DATE PERMIT/SERVICE REQUEST # WELL ID# <br />$10 (9e) Z 5 &87 <br />gso t VI 0- co 026.1 2 ,(' //PD --------------------- <br />S (k b 0 3 'iliS 1