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WELUPUMP PERMIT 14 <br /> SAN JOAMew COUNTY IhneRONMEHTAE H6 TH DEPT IS6e EsstlmaeNon Avenue-Sra,Tox CA9S20S6232-(209)4683420 <br /> MON-REFUNDABLE PERMIT CALL 209963-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Jos Aooasn. 4223 Mcdouaald Boulevard (Great Valley Elementar O,y2e Stockton,95206 <br /> Cnoss Ste", Bess PI APM 16802001 pwwcats.. 20_8 at L.Us,AeeLCAnaMM <br /> owrmx NAM. Manteca USD Pxoxe 209-825-3200 <br /> (Awren AOosEss 2271 W Louise Ave CMISTATd7,p Manteca CA 95337 <br /> Coram eros Dave's DrifluM PHosE 559-999-2603 <br /> Coxmwcros A. .. 5843 W-FA Ave CO`tISTATE9Fresno.CA 93772 <br /> Suscoi AACToa PHONE <br /> Sueco.,*se.AOoess CMISTATEMW <br /> Lrc.xae XC-6i7 Cbl D-09 _Other Musne, 804196 E.enaArbM D.te12/31!13 <br /> Geo.,,euMeosswaorc cowdso sex -121.29662 Y 37.90271 Township TIN Range RISE secties S27 <br /> Y,Trxnrnlr=r DomsencrPrtyate -lniJatarvAgritulhral IdAtial water O.Ady Monexng Shc samp(g'a7rar'amsr¢atian <br /> Pudic water System Dave Smith:559-9.99-2603 <br /> bra Dean. r.N�— <br /> TYs,a Won, N.Well Replacenent Well Well AltersteeM dineeten -.Other <br /> Monitoring Wee(e) Nodweas Sal Boring(.) XGeowelnieal 2 ...s% <br /> W-Of-Sovicewell OutOfServlce Weh RererrW - Cross-COnrleaion Repair 15 ft.max <br /> New Fe Pu R acansrt Fe R Ross Well Cam <br /> WE - TR -n Use Bentonite chips to 5 feet above GWE,then soil wtdngs to surface <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tod Push Pant Oiler <br /> Proposed Well Dept_-14"_ft Exavatian in diameter =.-Open BWpm Gravel PaWGra+el Sim in dianerar <br /> Caieucax Caanlgin diameter I Conductor Casing Depth ft <br /> Well Casing Demeter_n ThMkness/GaugWASTM Sled -. Steel Plastic Stainless Steel _Oder <br /> moon Seal Dept ft Neat Cement(94 lbb.95-10 gat water) Sand Cement sack mid?gal wemr <br /> Benonde(20%SCIW$) Other <br /> Grout Placement Method Purepod - Free Fail Oiler =Retardant l Accebrator Inane) <br /> T Installed By Order Perpcorvaaai Other <br /> Cw ste Pedestal Dimensbns'.width R LengtY R Thick m - Christy Box Stove P122 <br /> SubrnarsiNe_ Tondos Other HP Pum R Stand ylater Leval fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORN WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERSCOM nON�LAWS. <br /> 1 UM 2d HOU ANCE NOTICE REQUIRED FOR INSPECTIONS <br /> 7 Taus '0 <br /> CE VFD <br /> 12 7013 <br /> 4 <br /> MFI,T�MI <br /> AFM <br /> D,EPAjRTMENT SE JONLY <br /> Apr*ahon Accepted By Dat 3 Area <br /> Gw Inspection By Dam SPECIAL Well Permit I <br /> poop L+m••.B r _ DaOs WAIVER Received <br /> SW Bonnq hlQecton Dasa / COmtrucmd Well Depth ft <br /> emtU <br /> Codes InloBY, sM RsmiMd Date Service R oast N Invoic®M Wdl IDN <br /> �oPIL <br /> s�71 %0 o S <br /> ea�sOa wecmae wisest <br />