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mi hay ,S an Am <br /> WELL/PUMP PERMIT <br /> SAN JOAMN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPEC71ONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe AoMES9 AODlication 2 of 2: 1181 Zuckerman Rd Cny2P Stockton CA 95206 <br /> a <br /> CROSa STREET Access Road APN 129-031-012 Ppp(,-EL S6E LANn USEAP AnMs p <br /> Ovmee NAMEPacific Gas & 1 t mn-ny Attn h'r Hren Ma da PHONE (925) 328-5637 FL^ <br /> OYMERADMEW 6121 Bollinger Canyon RdAFbW 190660 CIPIS.M1 San Ramon, CA 94583 1�E- <br /> CONTRACTOR American Conel: uCticn and S ypjy. Inc PHONE (415) 927-2024 <br /> CoNrppCm AoMeee 45 h9an 91e D i„ . Sui A-10 CIIYISTATE2e, Corte Madera CA 94925 <br /> SUSCONrRAcrok N/A ppgda <br /> SUACONmpGTM ADDRESS CRYISTATEMP <br /> LICENSE XC-57 ^_CSI D-09 -Other NWUR 310599 EmRAIMDATE 03/31/2019 <br /> GEOORAFreeALINFORNATION: CeoMlnataaX 37.988229 Y -121.479492 TownsNpJL Range 04E Setlon_2.,,'+- <br /> INIENDEDUSE -DomestkJPriVate 7 InigadoNAgdcuRurel �Industrial C.Wafer Ouality Manit ring C Soil Sampling/Charadertmgon <br /> Public Water System <br /> I me • •mo ar re um <br /> TYPE OF WORN XNaw Well _Replacement Well -.Wel AnaragaNM thu, XOther Cathodic Protection <br /> _Monitoring Weals)_sofwels XShc eonng(sl sdmn L.GeoteChnkal eo1°0a"0' <br /> Out-Of-SerAlce Wel -Out-OfSeMce Well Renewal L Cross-Connection Repair <br /> -Naw Pum - Pump Replacement Pump Repair Raise Well Casco <br /> WELL CONSTrtUCTIDN <br /> Drilling Method - Mud Rotary -Air Rotary X Auger ”'Cable Tod Push Point IOther <br /> Proposed Well Depth 15 R Fxcsv dion 10 In diameter 7 Open Bottom '_Gravel Peck/(Lavel Srze In derunter <br /> -CandactMCasIng N/A indiametm / Conductor Casing Depth R <br /> Well Casing Diameter WA in Thirkrwss/Gauge/ASTM Schad N A ]Sled C Plastic c Stainless Steel Omer None <br /> Grout Seal Depth 2 S X Neal Cenrent(94 lb bey5­/0 gal wale,) ._Sand Camera sack miA!l galvwNr <br /> _8e,00nite(20%solds) J Other <br /> Grout PMcament Method 1Pumped XFree Fall Other -Retaldanll AcceleraUw(name) <br /> PEDEETLL IneLllad By X Driller ;Pump Contractor Other <br /> _Concrete Pedestal'DYnensions:Width —it Length RThirk_OI XChriety BOA -Stovepipe <br /> pme _SubmersibbC Turbine -Other HP Pump Set R Standing Waler Lave) R <br /> I HEREBY CERTIFY THAT I HAVEJIVIEPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANC -STATE JAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WIE CAU <br /> COMAND SAI! PORNIA CONTRACTORS STATE LICENSE BOARD AND THAT AM IN COMPLIANCE WITH ALL <br /> MINIMUM ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> Blown Steve McKim Tr rLE Vice President DATE 04/04/2017 <br /> FyVOgpU/ � 10/7 <br /> IT �FN ,yrTAY <br /> 4f <br /> DE RTMENT U E N L Y <br /> Applka9on Accepted BY Date 77 Area Employee) ��"�1'�'�('y�/m/WI/✓/ <br /> Groh Inspecti Data C SPECIAL Well Permit <br /> Pump Inspection By Date = WAIVER Received <br /> Soil Banrp In °�On 9y Dale CamUucted Wall Depth R <br /> COMMENTS i"F/i 7.e��'7)�-/ MILES �t71L UJB//7� G!J VWn kA-' <br /> PE SC Raealved ehacNv AmourK �� PermPo involeap WOS IDR <br /> Coda <br /> Into Cash Remlded Service uesti <br /> �1 l�I 9 , y5 -1 S OOhl5 <br /> -71 111 <br /> _dLD <br /> E. a]e <br /> Mu NVMP GERYn <br />