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LM '°N Wh' :ti [ LIN '9I 'SI1d ;W11 paAI;D;� <br />S <br />WELLIPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRCNhIE YTAL 1fSALTH DEPARTMENT 1668 EAST HAZELTON AVENuE - STvcic/OH CA 9=05 - (Z09) 4NS�3d20 <br />(YON -REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 'I YEAR FROM DATE ISSUED <br />JOB Ax28250 Flood Rd CnyrLp Linden, CA 95236 <br />Cross STREET E s c a 1_ o n Be 116 tAN r d 0 9 3 2 9 0` L-9 ML SIS LAND USE APPLICAroN T <br />OWNERNAME Chaffee Ranch LLC 209-40T-9784 <br />�( n PHONE <br />DtTNbRADDRc552 0 0 f ��1 _ r r„ q� dfTyISTATR0 i n (� a n t <br />(CONTRACTOR TP�urviaTn�ce GDrill.ers, (�innc.. PHOUE 209-887-3554 <br />CONTRACTOR ADDRESS r - O • Box v a' CrrfjsrATEmp T� inden P Czk q rj 7 3 <br />SUBC-ONIRACTOR <br />PHONE <br />SUBCONIFRACTOR AOURESS CIS -1I <br />LiCtNSE L_ G7 _ C-61 ,. D-09 _ Other NUMBFR 377923 ExPlRA-RON DATE 7 / 3 T ! 1 9 <br />GEOGRAPHtcALINFORNIATJON. Coordinates X Y Township L,z...._... �__ P _ Range Section <br />---- -- ��•j•v!.= Wangauonutgnculturdl E: Indus Mal C WalerQUaRyMonitonng - S-1 SarlpGnglCharar�erizaCron <br />Public Water System <br />Irdiffe--m rmm Os ,r er ys amc a erne cr ne meer <br />TYPEOFWORK New14r011 IReplacement Wall WelIPPeration/ModiflcaGon Other <br />Monito Ing Well(s) : of wells ' SCIl Barings) =of Cerirgs ^ Gealechnicat <br />New F <br />n Service Weil OW -O' Service Well Renewal 'r Cfoss-Connection Repair <br />r New Pump -Pump Replacemen - Pump Repair _ Rase Well Casino <br />Who. <br />Drilling Method _ Uud Rotary - Air Rotary . Auger _ CablaTool _ Push Point Other <br />Proposed Well Depthft Excavation in diameter L: Open bottom fU <br />Gravel pacGrauet Size in diameleri <br />Conductor Casing in diameter ! Conductor Casing Depth (( <br />Well Casing Diameter_ in ThidmemVGauge1ASTrJScheO Steel Plastic C Stainless Steel Other <br />[Grout <br />GroutSeat Depthn l7 Neal Cemxnt (941b bacy5-10 q& Ivatel;Sand Cement ack rroxl7 gal tracer <br />Berdonite 1.20% solids)OtherPlacemertMethod Pumped r- Free FW ' Other Rela•,dant / Accelerator (name) <br />PEDESTAL Installed By a Cnger ,; Pump Contrador - Other <br />Concrete Pedestal 0(meRslons lfJtllh 'tt Length it Thick in Christy 5 . Stovepipe <br />p=1m Submersible&Turbine :; Other <br />, HP Pump Standing Water level O tt <br />1 HEREBY CERTIFY THAT ! 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_ 1 ALSO CERT([ Y THAT MY REQUIRED LiCI;NSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WOR MPENSATTON LAWS. <br />i <br />MI M 24 AD NCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 <br />SIGNEb •''� -�- w T, Corporate SecretarNv, 8/16/17 <br />Im <br />b <br />a <br />1i�1■■■■X16,'tZll�■■��■■LRi�: <br />■iANN <br />E!�L'■!■■■■■■■■qa <br />ME <br />_ <br />1■■■® <br />■■iii■l■■ <br />• . <br />i■�i��q■iq■■!•■■■i7�■■■■■i�'■q■li■■■■■■■��i■ <br />, <br />' <br />n <br />■'U■■■i■■■i■■■i■■■INTI■■�■i■■0■/li■■■i■■i■■E■►f <br />■■qvi■■glii■■■ii <br />■■L��i■■■i■■■■i■■■■■fl�liiv■i■illE�li■■ii■■1■l� <br />-loom ■!MME i!MEN <br />imoms ili■I■li <br />" = <br />■■IRL�II■Igq■i■■■■i■�i�=ii�i■�igi■=iii■ <br />■i■■i■i'lfi�w <br />i57 <br />i■ i.�li■li■■■iii!■■■i■i■■i■ii■i■■■■■�■■■gRim <br />■1.�liq�i■■■■ii■iliii■■i■il■■i■i■i■l■■■pMINE, <br />. <br />i, , <br />1■'Ni■■ Aii■■i■■■■■■■■■■■■■■■ii■■■■■■q■Ili <br />lei■■■■D■■� <br />■■iiN■■i■i■■■ �■■ <br />■■■■■■■■■■■■ii■■■■■i■■■■N■■I <br />MUSEUM <br />■ilii■■■■■ii <br />■MINM■■■■■■i■■a <br />■■■Vq■!!!■■■■■■!■■■■i■i■li■illi/■!i!i■i!■it <br />■■■i■oi■■■■■lii■■■■ilo <br />ii■■iii■■■■■■B■i■i■■■ <br />■i■■■■■■i■■�■■i■■i1 <br />i■■Iii <br />■�I <br />_ <br />WE <br />., <br />e <br />