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O SE "N ARO: 81H '�['ApA Buhl paA19�;� <br />WELLIPUMP PERMIT I <br />SON J CAQUIN C W NTY EetvlltON MENTAL HEALTH DEPARMMIT 1868 EAs rHamroN AVn3Af E-STOOITDN CA 95205 - (20S) 451 -WD <br />NON-REFUNDABLE PERMIT CALL (209) 9�9-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Jae <br />Waterinn Rd <br />Comstock RD APN�J�. T� <br />iov���,,,E Luis Fernandez <br />10WN137ADCR9a" 10246 E Waterloo Rd <br />CONTRAMR Purviance 'Drillers, Inc <br />CONTRACTOR ADDRESS -PD Bog 64 <br />SUHCQVIRACTOR ADDRESS <br />UcErzse }� G57 D Cal 0 O9)9 U <br />cr,fz,St_ockton CA 95215 <br />ICE>L Ste0-71-Am use ArPucaryou* <br />PrortE209-298-4549 <br />CrrYJSTATE0PSt0C Ic t0n9 5 21 5 <br />PHONE 209-887-3554 <br />cmfs,7,z,PLinden, CA 95236 <br />PH ME <br />CM,ISTATEMP <br />NUMBER EANRA-11011 <br />T <br />DomEsTz WaLSAwL w. C General Mineral/Coliform Bacteria (4391) F. Dibromochloropropane (4392) , Arsenic (4 393) <br />INTENDED USE 0DarneslicJPrivale C InlgabenlAgriculWral = Industrial C Water OuarityMorvtering O Sol Sampbng/Char`.cteriraton <br />u Pubic water sy3tCn <br />fldf acw rmm Ovrzr. MWSpt[ Name Conlffi Nana -Phone Ncber d a <br />TYp��r07 wOR` 0 New Well G ReplamnenlWell C Well AheratioNModkfr®tion U Other Lr <br />O MordIoriag WaE(s) #aiweiIs G So6Bortag(s) acraon.,gs C Geotechnicat aor JO <br />J out-orSeMcavyell C OutC!SerViceWa Renewal O Cross-Cannertim RepairT' ,,_ ElillnA� <br />!DrlllingMethod O Mud Rotary C Air Rotary O Auger O Cable Tool O PushPOint O Other <br />Proposed Well Depth it Excavation in diameter D Open Sattom D Gravel Pack/Gravel Size in drameler <br />CICandudceCesing indiameter / Conductor Casing Depth ft <br />Well Casing Diameter_ m ThICXtw aiGaugeLASTM Srhed D Sled C Plastic O Shtinless Slee? 3 Other <br />Grout Seal Depth ft ❑ Neat Cement (94 lb bacy3-f0gal wafer) C Sand Cement 5817c rnW7 gal tvaler <br />I U Bentonite (20% sours) 9 Other <br />Grout Placement Me" G Pumped ❑ Free Fail C Other ❑ i2etardantlAecetNator(nanne) <br />PEDEsrAL Installed By 0 Cdler O Prang Contractor D Other <br />Ll Concrete Pedestal DDimenslonsr Width It Lenplh RThjck in 7 Christy Boz R Stove Plpa <br />UM11P APSiArnefsibleo Turbine D Other HP—j Pum Set n Standing WalerLevei R <br />I HEREBY CERTIFY THAT 1 14AVE PREPARED THIS APPLICATION ANO 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 REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE UCENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH All <br />Walu <br />PEN S. <br />VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />sls. Uca�z Timor porate Se cretar&,, <br />AnplicaJan Accepled By <br />Grout Inspedion By <br />Punp ln5p -ton By <br />Soil Boring Inspection By <br />COMMENTS _ <br />a <br />D <br />71 <br />d <br />n, <br />z <br />ML <br />— m <br />M <br />rrT <br />c., -r; <br />q <br />i's'11 <br />o9c <br />� <br />PA HENT U E 0 Y <br />r — Dare Area Employee IOU <br />C,E/IAL WBII POrMitOs1e� <br />t' Date 0 WAIVERReceived <br />Date Constructed Well Depth tt <br />9401-6 a &VV16 <br />(x--� --# 78'7 Ian <br />VCni- MMP=SRMrr <br />t -d VZ9£L9960Z out s.iejjuQ eoueifund dZ9:£0 9L 9 L AeW <br />