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I <br />6851 "N WVEN M6 '66'APA aw!1 paA I;O;� <br />+/ <br />9 VVELIJPUMP PERMIT <br />SAN .IOAOUTAI COUNTY ENVIRONNIElaTALHEALTH D=_PARTM E.VT 1369 EAST HAZELTON AVENUE-StnCKTON CA 95205 - (209)468-3420 <br />NON-REFLINDABLEPERMIT CALL (20 3-7697 FOR tNSPECTIONS EXPIRES 9 YEAP.FRoM DA7FISSUED <br />JDaADDRESS 20663 N Van Exel cramp Lodi, CA 95242 <br />GROSS STREEW o o d b r i d g e aPN 0 1 1 10 0 0 8 PARCEL SIZE 1 91 -L IJSE APPLIC n <br />OWNER NAME Lodi Farm Limited Partnershi��. AIDS �/� <br />POBox 280 ' <br />OL'rNER ADOR-c55 CITviSTATEIZIPs t a n f i e 1 d y AZ 85172 <br />CoNTRACTOR Purviance Drillers, Inc. PHONE 209-887-3554 <br />CONTRACTOR ADDRESS P. 0. ROX 54 CITYISTATEG&P Linden, CA 9523 <br />PHONE <br />SUSCONTRACTOR ADDRESS CITYISTAIEfZIP <br />Llcc'risE �( asp _ C-61 D-09 _ other NUMBER 3 7 7 9 2 3 E>pIRAnoN DATT= 7131/17 <br />GEOGRAPHICAL INFORLIATEN: Coordinates X Y TCwnship_ Range Section_ <br />RrTENDEDUSE DamesbCIPrivele fT9abOr11Agricaltura4 _.Industrial 7, Water Quality Manitoring Si ilSamplinglCharacterzalion <br />._ PublicWalerSystem <br />Irdifferemrmm Ow r Yvater ys me a t. ameur one maer <br />TYPE OF WORK NewbVell _ Replecernent Well N.; Wdl PlleraliordModification _ Other <br />Monilotin Wells) :nfwejs Soii Bon s scr�erings +or Dari ys <br />g ( 9l) Geotechnical <br />Out -Cf -Service Well _ Oof-011-Senrice Well Renewal � i Cross -Connection Repair <br />New Pump Z Pump Replacement :- Pump Repair = Rasa Weir Casinc <br />VELI. CCNSTRUC Tip`; <br />Drilling Method * Mud Rolafy - Arr Rotary . Auger _ Cable Tool _ Push Point _ Other <br />Proposed Well Depth Y; Excavation in diameter --Cpen Bottom --.Gravel Pat;VGravel Size in diameter <br />Conductor Casing in diameter I Conductor Casing Depth ft <br />Well Casing Diameler_ in ThicknesslGamgelASTM Sched :. Steel 7 Plastic : Stainless Steel Z! Other <br />Grout Seal Depth tl -Meat Cement (94 Ib bagr5-10 gat tvatei) _Sand Cement sack mbcl7 gat water <br />Bentonite (2". solids) ; : Otter <br />Grout Placement Method Pumped Free Fall = Other _ Retardant 1 Accelerator (name) <br />PEOEs7:.t Installed By _ Driller - Pump Cenlracta _ Other <br />Concrete Pedestal:_ Dimensions:Widlh it Length RTh:tl: in _Christy Ban U Stovepipe <br />Pump SubmersibleATurbine Other _ HP _7 Pump Sat y ft StalWing Walerlerrl ft <br />I HERESY CERTIFY THAT I HAVE PREPARED THUS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY RPCUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />PAINI M 24 R VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITS Corporate Secretary 5/29/17 <br />m <br />e <br />a <br />a <br />m <br />m <br />�>_,v��tt��..-. tatatatata���t��H��ta <br />■■..■■ .■MEMO■■■. <br />��Ilaa■s����r�a <br />MMMM■MM■Vii <br />s•tau <br />I Pan" <br />Date 1 Service Request t.t Invoice# <br />Well M# <br />..■ MEN .MEMMU■MM■MEM.....OE <br />■■■■ i"■■■■■McM■=■■0SEEM <br />an■EM■■�■■■■■ <br />MEMO <br />0.V <br />SIZ L% s <br />■■MN■ME..■■■�■�u�■sM■■��n�■■■�■M■���■■■■ <br />, <br />■■■■Eric;,�ils�■■ii■■■■■■■■MM■■■MSM■■ <br />l <br />i <br />MMM■■■■MMM■■■■■■■■■■E■MM■■■■■■■■■■�uii <br />E■■■■■■■■■■ <br />MMM■■■WOMEN <br />■■■MM■u■■■■■■■.r, <br />■■ <br />.■ <br />u <br />; <br />t <br />fi MMMMM■■■MM■■M■Miiiiiiiiiiaai■Mmii� <br />3�E <br />Mii� <br />■oMEMMM■Mi■M■■■E■M■E■MEMULM� <br />• ' W"M■■ ■MEM■■MMEME! <br />■ ■ ■ i■■■ <br />"■■■■■■■■■nM■MMOM <br />MM■■■■M■■■■M <br />■■■ME. <br />PE <br />Codes <br />SC I Received CheckX <br />Info By Cash <br />Amount <br />Remitted <br />I Pan" <br />Date 1 Service Request t.t Invoice# <br />Well M# <br />06 <br />0.V <br />SIZ L% s <br />o037*51 <br />1 <br />l <br />i <br />n-7 � � _ - aL 1PU UP r -ER ::!T <br />4rSN12 \I/`\J\ <br />Z'd VZSU9960Z <br />out sielp4 eoueirund 1260:60 Z L 6Z A13N <br />