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Environmental Health - Public
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EHD Program Facility Records by Street Name
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BETHANY
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17103
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2900 - Site Mitigation Program
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PR0524391
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Last modified
2/7/2019 5:22:44 PM
Creation date
2/7/2019 3:57:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0524391
PE
2965
FACILITY_ID
FA0016362
FACILITY_NAME
MOUNTAIN HOUSE WWTP
STREET_NUMBER
17103
Direction
W
STREET_NAME
BETHANY
City
TRACY
Zip
953917301
CURRENT_STATUS
01
SITE_LOCATION
17103 W BETHANY
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)468-3420 <br /> NON-RE ABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED q //7 o <br /> JOB ADDRESS �P 1 Q CJ iyL�yt- APN r2 P <br /> r^ <br /> C1TY/ZIp r1LJ /_�CI�i[� � PARCEL SIZE ��+C-SU <br /> OWNER NAME Y`f q.f"I\ �IJNN�-�"yl�FADDRESS <br /> CITY/ZIP PHONE <br /> CONTRACTOR V IL W -D 2 I I L I N 5 ADDRESS P O 3 o X .S/ <br /> i <br /> ary/ZB' 410 Vit-r,+ 9 1/S 7/ PHONE 1 Ali 7 7 7 4(1 O-0 C-57 LICENSE# -Z-9- <br /> EXP DATE <br /> GEOGRAPHICAL INFORMATION: COORDINATES X_ Y_ TOWNSHIP_ RANGE_ SECTION <br /> ,,y -3S',3n ys YDS I <br /> TYPE OF WELL: 11 NEW WELL 11 REPLACEMENT WELL yah MONITORWGWELL#ao,i��ro ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR - ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW ❑REPAIR H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL <br /> I <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOI.BORING ❑DESTRUCTION: <br /> I <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION Alk <br /> ❑ INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA S / CONDUCTOR CASING DIA TVTL <br /> �5gA <br /> -❑DOMESTIC PRIVATE ❑GRAYE6 PACK/SIZE O•o/O WELL CASING TYPE V CV C- WELL CASING DIA .2- •T <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUTSEALDEPI'H SPECIFICATION��JJ <br /> ❑IRRIGATION/AG OTHER GROUT BRAND NAME �A6:� ja"AX tf <br /> KMONITORWG - GROUT SEAL PUMPED: ❑YES 0 N <br /> ❑CHRISTY BOX 9STOVE�IPIPE CONCRETE PEDESTAL B.{/Y DRILLER: �❑Y/ES, 13 NO <br /> APPROXIMATE WELL DEPTH_,2S/,'r*,JC ST <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY_AIR ROTARY AUGER_CABLE_ OTHER <br /> _-.__.._......... . ...__.._ .. .rrror♦n11.l V..R QAN <br /> . . .. .... ... <br /> CONDOR EARTH TECHNOLOGIES, INC. MERRILL LYNCH BANK ONE 044131 <br /> P.O.BOX 3905 COLUMBUS N.A. <br /> SONORA,CA 95370 COLUMBUS,ON 43n1 <br /> (209)532-0361 'Sfi°1610 44131 <br /> CHECK NO. <br /> Exactly Four hundred and no / 100 Dollars <br /> DATE AMOUNT <br /> 2/7/01 $400.00 <br /> )AY San Joaquin Public Health Svcs <br /> ROHR <br /> ORDER 304 E WEBER AVENUE <br /> F STOCKTON CA 95202 B <br /> VIA.r.`? <br /> f <br /> ££LURK'F-IATUNES MICRO THIN TUN S OOT TOM SCREENS-COLORED PATTERN ARTIFICIAL WATERMB 209-31AHB ON REVERSE BIOE-MISSING f[giURE MU2ATL5 A COPY 209-1fi0-1 � 209-I60-2 i 209-370-8 <br /> \ TH UNE OF 6 <br /> BETHANY RO.\ <br /> 3 <br /> 'P <br /> 0209-150-30 <br /> -30 <br />
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