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EMAIL_ED 1 t Laq 4 s> WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)469-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED 'I 598d En JOB ADDRESS E Eight Mile RD Linden, CA 95236 CITY/ZIP r m CROSS STREET Tully APN 09108029 PARCEL SIZE 3 ' LAND USE APPLICATION# p OWNER NAME Solari Ranch Produce M PHONE N PO Box 477 Linden, CA OWNER ADDRESS CITYISTATE/ZIP CONTRACTOR Purviance Drillers, Inc PHONE 209-887-3554_ CONTRACTOR ADDRESS PO Box 64 CITY/STATE/ZIP Linden, CA 95236 SUBCONTRACTOR n/a - ---... PHONE SUBCONTRACTOR ADDRESS CITYISTATE/ZIP LICENSE X C-57 ❑ C-61 i7 D-09 ❑ Other NUMBER 377923 EXPIRATION DATE 7/31 /2 0 2 5 DOMESTIC WELL SAMPLING:}General Mineral/Coliform Bacteria (4391. lbromochloropropane(4392) Arsenic(4393) INTENDED USE ?Domestic/Private [] Irrigation/Agricultural iI Industrial I Water Quality Monitoring ❑ Soil Sampling/Characterization I I Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK •New Well jGReplacement Well U Well Alteration/Modification ❑ Other I I Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings ❑ Geotechnical #of borings [I Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair [I New Pump [I Pump Replacement U Pump Pe air U Raise Well Casing WELL CONSTRUCTION Drilling Method )(Mud Rotary [I Air Rotary ❑ Auger U Cable Tool U Push Point ❑ Other Proposed Well Depth Z5 ft Excavation 12'lq in diameter XOpen Bottom 13 Gravel Pack/Gravel Size in diameter I I Conductor Casing IJ 0 in diameter / Conductor Casing Depth ft Well Casing Diameter&-"IP'in Thickness/Gauge/ASTM Sched ,I FV XSteel U Plastic D Stainless Steel U Other Grout Seal Depth d DO(+/) ft H Neat Cement(941b bag/5-10 gal water) >f Sand Cement ID-3 sack mix/7 gal water U Bentonite(20%solids) ❑ Other Grout Placement Method X Pumped U Free Fall 1-1 Other D Retardant/Accelerator(name) PEDESTAL Installed By iA Driller U Pump Contractor U Other Concrete P destal UDimensions:Width ft Length ft Thick in [I Christy Box [1 Stove Pipe PUMP U Submersible[I Turbine [i Other HP Pump Set ft Standing Water Level ft Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture,Industrial cell,provide location of any water wells or surface water within 200' radius of proposed well. AIINI%1U.N!24.IOI aDI'ANC'E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)"3-7697 EPARTMENT(�U_ E O LY Application Accepted By Date Area Employee ID# �C Grout Inspection By Date �� (� 1-\ ] SPECIAL Well Permit Pump Inspection By Date -1 WAIVER Received Soil Boring Inspection By Date Constructed Well Depth ft CO ENTS !' Li .� ,u,— ./ — l7�tu :" . b,2..?t kej7,ft 7 PE Sc Received Check#! tAmount Date Permit/ Lj Invoice# We I Codes Info B Cash Service Request# i P00 54 NVl C APR EHD043-060401^0" /I I n n Q �(] Page i of 'SA %Ve . mp Penult N IRONM COUNT'/ HPAi T, - ENT,