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WELLIPUMP PERMIT <br />SAN JOAQUIN COUNTY ErmnoNMENr2 TH DEPARTMENT 6Da EAST MAIN STREE r: KTOMCA 9622 - (209) 468-3420 <br />TION -RL FUNQABLE PERMIT CALL 208 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM [SATE ISSUED <br />.Ton, ADDRESS 3633 Duck Creek Road crrfMp Stockton, CA <br />CRD5S STREET APN PARCEL SIzE LAND USE APPLICATION m <br />OWNER NAME Ryder Truck Rental PHONE <br />OWNERADDRE55 1530 S. Church St., ,Ste. 3D1 CrnrSTATEmp Murfreesboro, TN 87130 <br />CDWIRACTOR CGRS , Inc. PHONE 916-991-1100 <br />CCNTRACTURADDRESS 5444_ Dry Creek Rd -- CrrYfSTATEMP Sacramento, CA 35838 <br />SLI13COMACTOR PHONE <br />SUDCDNTRACTOR ADDRESS CITYISTATEMp / <br />LICEI22E II C-57 ItC-61 it D-00 I Olhar HAZA NUMBER ®03616 EXPIRATMutDATE. 1/31/10 <br />GEaaRAPHICALINFon MATIDN; COordInBISS X Y 'rnwnnhi❑ Rnnnn c.,. -r 1.... <br />mENDED UBE R�DOm8sliclPrivals D IrdgailontAgricultural C laduulriat 3 Waler Quality Manllorirarl _ D Soil So;11nlChare;larizallanC Public Water SystemED fe-c 21121ts !y{v�af/j�/�- Pr 6O <br />�`ne urnuci ' <br />a +•— rrci a Mup!—"mr uk vvell L 'Nell H11Era11onWad{(CallaR 3 Dither <br />11 MonflPring Wolllsl T, of wells D Sol[ Badng{e} a nI hadnan p Gealechnlcal v ur6mhrpa <br />3 Out -Or -Service Well C Oul-Of-Survive Edell Renewal 11 Cross -Connection Repair <br />3 New Puma -1 Puma Rnn}anamnnf r Plana Rcnnlr <br />Qrillin® Muthod D Mud Rotary J AlrRolary C Auger 0 Cable Tool O Push Pont J Oiher I%+4Cr'JWI NsA'M'u— <br />Pro orad Wall Depth d� '" <br />P P R E>axivadan / In diameter ❑ Open Bottom O Cravat FaGdGreval Siza in dlerneler <br />I CBndudcr Casing In diameter ! Concluder Casing Depth R <br />Well Caeinp Dlamaler f In Ttdchness1GaugeIASTM Schell D Sleet A' Plaslic O Slainlsss Steel D Other <br />Grout Seel Depth ft O Neat Cement (94 lb 68915-10ga) water) O Sand ComanL sack mix17 gal water <br />J aenfonlle (20% solids) 3 Other <br />Grant Placamont Method LI Pumped U Free Fall u Other .t RoLordant l Accelaralcr (namu) _ <br />(PEDESTAL Installed By D DnUrr D Pump CCmrDC1Cr n Other <br />—^ a GancrotO Pudosisl 01rnnn5ions: Wldlh it Length IL Thlcll en ❑ Chriety Box ❑ Stove Pip0 <br />lPua.,p ] S tunft sllrluci Turbine ❑ Clther_HP <br />I HE-REBY CERTIFY THAT I HAVE P119 -FARED THIS APP LiCATION AND THAT THE WORK WILL- BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. t ALSO CERTIFY THAT MY REQUIRED LI+CCEn-r.�NSE i$ <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD tih <br />ANn T1. 1 A" w u <br />rnuor inre .r <br />In <br />c <br />11 <br />;j T i. <br />(75 <br />Fri "3 <br />1-t'T 00 <br />I� <br />^J ir�G <br />DEPARTMENT <br />y SE /ONLY <br />Applirallon Accepted By fes- • 1� V+y Dale % V Araa Emplayae IQ:: <br />Grout tlnspacilan By y�. , Y _-, Qale SPECIAL Well Permit <br />Pump Inspedlon By Dale WAIVER RecelVed <br />Soil Boring Inspection By Dale Contruclud Wall depth R <br />COMMENTS <br />EHP4 s <br />N71Va7 WELL -PUMP PERMIT <br />