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WELL/PUMP PERMIT <br /> SAN JoAawN CouNry EmvmNwwAL HEALTH DEpARrmEmT 1114691 600 EAST MAIN STREET-STOCKTON CASS202-120%,46&4420 <br /> • NON-ReFuNDABLE PERMT ------9A INSPECTIONS EXPIRES I YEAR FRom Issu DATEEA <br /> jJ"A 11418 E. COMStOCk ROad Stockton 95215 TE ISSU <br /> CITYMP- m <br /> C 089-130-28 _154.0 <br /> Size -LAND USE ANIMATION <br /> NAME Lucia Grillo 931-1366 <br /> PHONE.- <br /> OwmEn ADDRESS 7198 13. Tully Road CTyISTATa7jp Linden, CA 95236 <br /> CONTRACTOR PHONE— 466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CATYISTATErZW­ Stockton, CA 95203 <br /> $08CONTRACYOR _—­-­­­ _ PHONE—­---­--- <br /> CrrY/STATEZP­ <br /> C 0-09 Other— NUMBER <br /> ----721jZ78— EXPIRATIONDAT9 08/14 <br /> 6909RAPHICALIWOR14AT40W Coord4ngktsaX_,­ Township—Range— Section <br /> ic/Pfivat$ 0 Im9atioWAgriculturaJ f,Inclusinal i.j Water Quality Monitoring L Soil Sampling/Characterization <br /> rambfiewater s'. -- <br /> C-0toNor i��nu'u Alriridarr CJ <br /> ­ <br /> TYPEOFW*RK :1 Now Won -Replacement wel; U Well Alteralion/MocifiCallon C Other <br /> o Monitoring Ws*$)----#Of Wells; D Soil Borings) Geotechnicai 0 of wingo <br /> Out-01-Servicel Wall, Out-Ol-Service Well Renewal Cross-Connection Repair <br /> V,Now Pump X �D Raise Well Casing Ur <br /> 6 <br /> MMhod o Mud Rotary o Air Rotary ;Auger Cable Tool C push point 6 Other <br /> — <br /> Proposed Wait Capth_ft Excavation_in diarnetor copanSoftm Gravel PadVGraveISIze—indiwn0t&r <br /> ,'3 CorafuCtor Casing�„�in diameter J Conductor Cas ng Depth__ft <br /> WOO C"Ing Diameter_in ThicknesWGatigWASTM Schad 0 Steel 0 Plastic o Seamless Steel .11 Other_ <br /> Gr"Sod Depth ,,,I <br /> __,it .7 Neat C4.4�rkt(94)b bao-10 gat water) r.1 Sand Catneirit_-­.sack nwv7 gal i;; <br /> U Bentonite(20%Solids) G <br /> LO.PIWSffk"t Method C,Pumped Free Fail 2 Other D Retardant'I Accelerator(name) <br /> By. ",Dr L.Ptialp Contractor li Other <br /> C,CO=W* D111101181011B.-Wift N Length_It Thick_in j Christy a* <br /> x SUtNha15 file�TurfsUea .:;Other HP Pump Set 15` It Ste water Level. i 3 1t <br /> I 40RE111Y CERTIFY THAT I HAVE PREPARED TM APPLicAmN AND THAT THE WORK'WILL BE DONE IN ACCORDANCE WITH:SAN <br /> JOAWN OOUNTy ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE Z <br /> • THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT..I AM IN COMPLIANCE W=Z��w$1 IANCE WMI ALL <br /> UINRA Z4 HOI� <br /> _�VANCE NOTICE REQUIRED FOR IN6PEC71ONS-PLEASE CALL(209)953-7691 <br /> SIGNED Time CEO DAT, 08/21112 <br /> --TTT7-F <br /> IL ih flhk t-4(�k <br /> 7- V <br /> 777 <br /> 14T <br /> D AR UFNT US ONLY <br /> 4ppllcikli-Accepted By e Area—004 Emptay"tw-5 <br /> DatenSPECIAL Well PermIt <br /> PtIzap 1. al, Z C WAIVER Recelvw <br /> 8041180iing Inspecilon,Sy L Date Constructed Well Depth--,_ft <br /> COhNENT I S i7-4&- z4az; ;; <br /> /.;4- A , <br /> 7 L, <br /> PE' , SC Awehmd Aftount Date Invoke I W*41D* <br /> Codes wwflo Remitted <br /> Wru.akmp PEANUT <br />