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Site Address: 9417 S Orchard Rd, Acampo CA 95220 Record ID: WP0043043 <br /> Date: 5/16/2022 <br /> PHOTO# 1 New Well.Well Log. Grouted from 100 ft usin 10.3 sand cement. <br /> e <br /> SAN JOAQUIN COUNTY ENVIRONMENT 1 <br /> NON-REFUNDABLE PERMIT AL HEAL DEPj,RI Z <br /> JOB ADDRESS •'1Ck 1 ALI <br /> CROSS STREET n <br /> OWNER NAME APN O`S,d/.✓ <br /> �o <br /> �I OWNER ADDRESS <br /> CONTRACTOR lV�� LS/�O 5.,� <br /> CONTRACTOR ADDRESS /ry/ , <br /> SUBCONTRACTOR , zz..V x � �193`L 1-6) <br /> SUBCONTRACTOR ADDRESS ZC'-7\<- <br /> 44 11 <br /> LICENSE <br /> DOMESTIC WELL SAMPLING:❑General Mineral/COlif 2 2 r3-- <br /> INTENDED USE Domestic/Private Irrigation/Agrie. ,•'� <br /> Public Water System Z 6d I?,->- <br /> If different from Owner 2- <br /> TYPE <br /> TYPE OF WORK ><ew Well Replacement Well <br /> Z <br /> Monitoring Well(s) #of we <br /> Out-Of-Service Well <br /> New Pump Pump Replaceme <br /> WELL CONSTRUCTION / �-d-4' <br /> Drilling Method-%<-Mud 59tary Air Rotary / <br /> Proposed Well Depth d a It Excavatio `J SZ GL l <br /> Condu r Casing in dia l <br /> Well Casing Diameter in Thickness/Gauge <br /> Grout Seal Depth /'2a it Nea(C 3 S3 `3 ✓ c <br /> Bentonite(20%solids) Other_ A <br /> Grout Placement Method .6e-urnped Free Fall / <br /> PED_ E_ s_TAL Installed By ' Diller Pump <br /> Concrete Pedestal Dimensions <br /> In <br /> Christy Box Stove Pi <br /> IPUMP <br /> ,+Submersible Turbine Other <br /> Plot Plan Requirements: Attach a plot plaf <br /> Coordinates, propert} lines, adjoining prop <br /> _.,.,rt,l sources of contatninatiorA,^s'w9'nn <br /> Francisco Garcia Ruiz, Environmental Health Specialist Page 1 of 2 <br />