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WELL/PUMP PERMIT 1-11 BCE #10199 <br /> SAN JoAQUW Coutm ENNROWEMALHmv DEPT 1866 East Hazelton Avenue•SmcmNCA952066232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1630 EAST HAMMER LANE Cm/LP RTOCKTON. CA .959. <br /> CROSSSTREET NEST LANE FRONTAGE RD APN 094-280-13 PARCEL WE&OLANo use APPucnn"R N/A <br /> OWNER NAME COSTCO WHOLESALE PHONE 425-313-6100 <br /> WN <br /> OMER ADDRESS P.O. BOX 35005 C,,MTATEM, SEATTLE, WA 98124-3405 � <br /> CONMCTOR JONES COVEY GROUP, INC. PHONE 909-972-7581 wo <br /> CONTRAOTORADDRESS 9595 LUCAS RANCH ROAD #100 CATY/STATMP RANCHO CUCAMONGA, CA 91730 <br /> SU9DONIRACTOR LEAK DETECTION TECHNOLOGIES LLC pow 520-207-4878 y <br /> 1400 EAST PASEO PAVON <br /> SuecoMRAcroR ADOREss Clrr/SUTErAp TUCSON, AZ 85718 <br /> LICENSE Ii C-57 I I C61 II D-09 I Other NUMBER 804431 EXP M.NDATE 8/31/2013 <br /> GEO(NWHICALINFORMA7ON: CoordlnatesX Y TOWnship_ Range_ Section_ <br /> IMENDEDU9E 7 DomesgcJPdvale OIRIgatordAgdcultural KIndusbial 3 Water GuaGly Monlorfrp 7 Bal Sampling/Cheractedzetkn �y <br /> 3Public Waters em NZ <br /> NdIW. tsm <br /> Tr EOFWORK 7 NswWel oReplacement Well L Wen AltemUonModification XOthe, ELI) MONITORING N <br /> MOnitodng Weg(s) 6 of wens D Scn BOrNIS) SurbNlnes C Geolechnkal <br /> D Out-OI-Service Well L Out-Of-Service W'e0 Renewal O Cross-Connection Repair <br /> •New Pump D Pump Replacement O Pump Repair 0 Raise Well Casing <br /> n <br /> tz <br /> M AIr Rotary L Auger D Cable Tool D Push Point D Other <br /> epth ft In diameter aopen BOl avel PecklGrevel Size In diameterI Conductor Casing_m diameter C Alemeter_m ThIckn& /GBuga/AS Flask O Stainless Steel 0 Other mepth aCement(94/b bagBTO gel water) 0San sack mW7 gal water N0%solds) D OtherMethod uPu d uFree Fen uOther .l Retardant/A omt"(M(Mme) <br /> EDEU Other <br /> ling <br /> uMP <br /> I HEREBY CERTIFY THAT I RAVE 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 CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> M I UM 24 HOUR ADVANCE NOTICE RED FO SPECTIONS <br /> BIOMED TRLE ATE 1/91 /9,011 <br /> of ARTMENT USE N77LY <br /> Application Accepted By F Dale / �J Area Employee IDRZL<�.s <br /> Cxoul Inspection By Date SPECIAL Well Permlt <br /> Pump Inspection By Data WAIVER Received <br /> Soll Boring Inspection By Dale Constructed Well Depth ft <br /> COMMENTS - r <br /> PE SC Recehred Checkill Amount pate Permitf Invoice Well IDR <br /> Codas Info Cash Remitted Servka Re uestif <br /> EM130d YIF11IP4NPPEIUAR <br /> SOWS <br />