FIELD DOCUMENTS AND WORK PLANS 1992-1999

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SAN JOIN COUNTY PUBLIC HEALTH SIGICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made,to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public Health Services. Job Address 150 North Sinclair City Stockton Lot Size/Acreage30 + Acres Owner's Name Marley Cooling Tower CO. Address 5800 Foxridge Dr. , Mission, KS phone 913 362-1818 Contractor laynta Fny,- rVlraS AddresQ0n9 S_ Hardy, Tam_ p,_A7 License No. 600468 Phone714) -155-13 5 TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION Cl Out of Service Well ❑ PUMP INSTALLATION [X SYSTEM REPAIR ❑ OTHER ❑ Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS _ INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS For EW-2, EW-3 IN Industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation Dia. of Well Casing Cl Domestic/Private IRI Gravel Pack ❑ Tracy Type of Casing_ PVC Specifications - 11 Public Cl Other fl Delta Depth of Grout Seal 48' /46' Type of Grout("PitiFint-Riantol i to I I Irrigation —Approx. Depth I I Eastern Surface Soul Installed by grouting w/ cement-bentonite & Dl Cin Repair Work Done ❑ Type of Pump GrundfoS H.P. State Work Done manhole Cover Well Destruction ❑ Well Diameter 61' Sealing Material a Depth Rpnt()nitp 4-S' 2 44' /4l ' _ Depth 96J115 Filler Material i Depth Grout 44'/41 ' to surferp v TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo septic system permitted it public sewer is C available within 200 feet) Installation will some: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms V Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLT. ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 6 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Lim SEEPAGE PITS I I Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the performance or the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall employ persona subject to workman's compensa. tion laws of California." Theepplic t call 1 all re/Q/u{rad/inJ�Pacoons�Complete drawing onreverseside./J (See Figure 1-1) J Signed X J i..l�r� Title: GYN-c.� /�c.ltc�.i Date: ?. ! �' /� �/( _,.[e,/� FOR DEPARTMENT USE ONLY Application Accepted by gyl Date 'r/J�1 Z Area Pit or Grout Inspection by Date Final Inspection by MTc.0-€-� Date Additional Comments: / /U Applicant - Return all copies to: San Joaquin County Public Health Services � J/ Environmental Health Permit/Services 445 N San Joaquin, P 0 Box 2009, Stich, CA 95201 y FEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT'NO. INFO . EH 3.24 IREV.r/m st EH 14.20