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WELLTUMP PERMIT <br /> SAN JOAQUIN COUNTY PURI JC HEALTH SERVICES ENVIRONMENTALHEALTH DIVISION <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 19530 1!_ GRAIITLI14E RD__. _APN 205-070-23 <br /> CITY2IP TRACY PARCEL SIZE <br /> OWNER NAME JOAIJrl BUCK ADDRESS 26964 AVE. 18Y2 <br /> CrTY/7.TP LAnFRr 93638 PHONE (559) 661-_$774 <br /> CONTRACTOR NE1°'J f%l ' DRILLING CO RIC, ADDRESS 3525 P E L A W D A L E AVE. <br /> cmvzip ADEST0. CA 95356 PHONE 545-1185 __C-57LICENSE#290813 EXP DATES-31-02 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y___TOWNSHIP_ RANGE SECTION. <br /> T'YPF.OF WELL: ❑ NEW WELL 93 REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR 0 CROSS-CONNE(TREPAIR O VAPOR EXTRACTION WELL#_ <br /> TYPE OF PUMP: O NEW i7 REPAIR H.P._ DEPTH PL'MPSET FT. FIRSTWATER LEVEL <br /> ❑OUT-0F-SERVICE WELL 0 GEOTECHNICAL# 0 SOIL BORING X 0 DESTRUCTION: 6"x App r1x_ 40' <br /> INIL14DED USE ''TYPE OF IVELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL O OPEN BOTTOM WELL EXCAVATION DI-A 1 2 t� CONUUCTOR CASING DIA <br /> )OO)OMESTIC PRIVATE UURAVELPACK/S¢E_ WELL CASING TYPE- WELL CASING DO, 6 _ <br /> ❑PUBLICIMUNICIPAL ❑DRIVEN GROUTSEALDEPTH 100 SPECIFICATION J'm'tC ite <br /> ❑IRRIGATIONIAG OTHER GROUT!]RAN'DNAME BARIOD - Quick Grout <br /> 0 MONITORING GROUT SEAL PUMPED: I`il YES ONO <br /> Q CHRiSTY BOX ❑STOVEPIPE 'G , CONCRETE PEDESTAL BY DRILLER: OYES 6 NO � <br /> APPROXIMATE WELL DEPTH___ '?4�9. _- IIT_-I <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY-3-AIR ROTARY AtJGER_CABLE OTHER 1, <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS.I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICF,NSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSA:PION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED ' ,`v b\ ��_--Tri SUPERVISOR. DATE 3-28-02 (` <br /> +! <br /> a x - <br /> cla r <br /> 13o i � <br /> 1346s ti i <br /> hi <br /> 1�5 I <br /> - <br /> 1 ,. <br /> u i <br /> D RTMENf USE ONLY <br /> A IiCatinn Acce [W B J• CL• (, L f Zg �^'� ea EMPID# <br /> PP P -' <br /> Grout Inspadon B,; mp Inspcctcd By _Dam <br /> Dcslruction inspcclion By <br /> COMMENT'S: i <br /> PE SC AMOUNT EC RECEIVED DATE PERMIT/SERV ICE REQU EST# 914VOICE# WEL:.IDA <br /> �. <br /> CODES INFO REM=D H BY <br /> 3 Z Z� 3/ag D"d <br />