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FROM <br /> (TUEIJUN 2 2009 18:11/8T. I8:16/No. 6801210790 P 1 <br /> SAM JOgOU1N COUNTY ENWROMMENTAL DePgaT WELL/PUMP PERMIT 0 <br /> BOO Egat MNN STREET-STOGNTOX CA 95202-($BB)d$B-3d2B <br /> NON-REFUNDABLE PERMIT CALL 209 9$3-7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS _3550 S-Hwy 99 cirrymp Stockton/95215 11 <br /> CROSS$TREET CgIDVflerAPN Ad g <br /> PARCEL SIM LAM USE APPLICATION <br /> OWNER NAME Vallev Pacific Pel oleLm CE P <br /> PHONE 209-993-61__ <br /> OWNER MORE,;, A Erank Wes[Circle <br /> Cmrl9rgTB/LP Stockton.C'A 57!1.5 <br /> cONragmon Leak Detection Teclvlolofties:LLC(See Attached) <br /> PHONE 5I0-207-4878 <br /> CONTRACTOR ADDRESS�4D0 a t Pac o payon <br /> CITY/$TATE/LP_TLLCNOIl A7 957(8 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCOHTRACTOq ADORES$ <br /> Crtr/SUTE/Zm <br /> LICENSE I'.C-57 1 C41 ]D-09 ;L Other NUMBED <br /> EXPIRATION DATE <br /> G90GRAPHJCALIWORWTION Coordinates y <br /> INTExoEb USE TavnMIP_ RRr1989aWon <br /> DOmeallclPnvate ?IrrigefioNAgbcuttural ';Induatriel i'Water OualHy MOMtoring !SOii SamplinglCharagadzalion <br /> Public Water System <br /> vmo<rcnl rrom wm<r a r m --'ti�Z oar one um r <br /> riPeOW '.New Well Replacement Well _:Well AtteraOanrtdotlKlzgbn XONer kD te�+'on <br /> MonitOdng WeH(a)_f of wets I Sol BPdng(s) a Mlwnhpa a M InhrNa <br /> 'ON-Of-$OMCs Well `GBoteUnicel <br /> Ou40fServim Wall Renewal !CrosstOnneglon ftapeir /. <br /> -New Pum rv.Pum Re lacement I Pum Re air �.Rahe Well Casin V1 <br /> WELL CONSTRUC <br /> OriliingMathod ';;Mud Rotary ii Air Rotary .;qu9er .I Cable Tool '.;Pueh Po'elt .; Other <br /> Proposed Wall Depth ft E%wvglon in diameter <br /> Conductor Cabin OPen Bottom i!GmYxi Pack/Gravei Size__In tliameter <br /> e__Indlametar / Conductor Ca6ing Depthit \�ytny <br /> We11.Gasing Diameter_In ThlcknesaVGauge/ASTM Schetl <br /> Gtout Seal DepthSteel :Reath r Shimideea Steel r.,.Other <br /> p 0 Otho Cement /b beg3.fOgal werer) ;Send Cement sack m%l7 gal water <br /> entonae(20%soHtls) Other <br /> Grout Placement MetBhod Pumped Free Fell I.Other <br /> .,ReteNentFAccehrator(deme' <br /> P.Q ' lMtalled.By Driller :,pump Contractor Ogyt <br /> Concrata Patleatal Dimension Witlltt_R Length RTI1Kk <br /> In IChrisfy BezStOve Pipe <br /> MP SubmerelbW T,1bme it Other HP <br /> Pump Se[_ _ft .Standing Water Level <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND.THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN \V\t <br /> JURREN COUNTY ACTIVE <br /> ORDNTH THE <br /> ES, CALIFORNIALAWS;ANDCONTRACTORS <br /> AND REGULATIONS. IALSO CERTIFY THAT MK WaterREQLevel <br /> LICENSE IS <br /> CURRENT AND ACTIVE WITH THE.CLItONTRACTOR3 STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE'WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> / IMAM 24 HOUR ADVANCE NOTICE:REQUIRED FOR INSPECTIONS <br /> sIDHED f_f/,• - TITLE CaWlockM er <br /> --�B DATE 6/?/2009 <br /> ..................... <br /> — <br /> PU PCnroI r� ��_� <br /> 1 I�nr Cyr ate' �---- <br /> •1.Cen�n�Ff ® �l.nry" <br /> PLwI <br /> /• p I N <br /> �r <br /> .q <br /> q., RECEIVED <br /> V•a1NFN 1. Y R..nol)µl nhl<1 <br /> LnI Is <br /> 0 3 2W9 <br /> L. '-Ir 4 8 '7 * JUN <br /> snv....o SAN JOAQUIN COUNTY <br /> 3..6 zl%e <br /> ENVIRONMENTAL <br /> HEAR-TN <br /> A M ate <br /> Appli putI= Date Area Employee IDk <br /> �� r161M Grout inspection By Data SPECIAL WEIR Permit <br /> Temp Inspection By Data WAIVER RDCe1Ved <br /> Sell BOdng Inapecli0n 8y Date <br /> COMMENTS f / Const Chad Well DePIN a <br /> I)n <br /> C <br /> ScRealvetl - .......... .. .y.. _._...— <br /> E CCashW Amount <br /> Codas IMo B Cash Remitted Data Parody <br /> q ltl Sheol.f{ Well 1W <br /> 43 <br /> MCC, l/.FiC�l1r'�\ FU's• rM" O S�7 ( I� WELLiPUMP PERMIT <br />