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WELL/PUMP PERMIT <br /> r SAN JOAQUIN COUNIV ENVIRONMENTAL HEALTH DEPARTMENT .104E WEBER AVE J"FL-STOCRTON CA 95202 -(209)4N-2420 <br /> NDN-REPUNDASIA PERMIT CALL26419$7-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB AUpRLu -3 Z_90 .. �/�9'Il dt/.t,.(idY1 Lh clTrnn TRACY <br /> Lee, Llton STREET KASSBKXKNX KOSTER RD. APN ���i 3ye)0'3 PARCTLSITE q1 loe <br /> OWIER NAME TC CONST now. 835-2470 <br /> OWNCRAmRrwF 47 W. 6th ST. Cm/REATUZIP TRACY. CA 95376 <br /> Lee coNrRwcroa HENNINGS BROS DRILLING CO INC Pinus 545_11R5 <br /> CorrtRACTDRwppeaw 3525 PELANDALE AVE CrrV)SrATean MOOFSTI)- CA 95356 <br /> SIIREDNrpwClpR Ilwrvf <br /> y SUBCONI'MCIOR ADDPE95 CDY/$TATFIZIP <br /> LICENsE 6C-67 ❑Cel C3 D-09 000p NVmsra 290813 ExwpArionDArf 5-31-03 <br /> GEOGMPKIGLIHPORMATIOn: CRN,B,etnt X Y T...Alp_ Relrye_ Seaton V 1 <br /> INrTIdDCDUW caUtevenecIineew, ❑IrrigvtivNApiwltural 01nauaviel OWear'Qudirymeeiloriug O Soil SamplinglCheructorimidan <br /> r ❑Pubbe Wier System <br /> IfdMetm tram Pon .iv Yvo-m rover w teed m �+• <br /> TvrE OF WORK d(New Well ❑KNAI:<mem Well ❑Well AlwaliuNModification ❑Tea ilole E3 Other <br /> O Monitoring Well(.) _ ninhPOl`NU 13 Soil Beiring(a)_ j°O°h'OIbO1ry1p ❑feoteetoical ninhf1Orb0""4` <br /> r ❑well Darverem 0Out-0FSe wo well 0Om-01-Sar,"Weil Rineeel <br /> ❑New Permit 0 Part,R W.1 ❑Pum R u ' ❑Crm-C t,,e ion Repi, <br /> N'EIICONfli [r/N <br /> Drilling Ne16nd r0 lE Mud Rotuy O Air RWry O Auger ❑Cable Tuol ❑Puah Point ❑(Mhe <br /> Prapvaed Wall Depth 200 R ExcevmieApen <br /> 12 iv diameter Cl O Bglem IXGravel Pack/Onv<I Sia N divmMer <br /> ClCiet VC1IXCising Indlame4' / CA11dwRNCiUing Dtplh R <br /> Well Galog Diamerer 6 I­ie4rNwGa.rJASTkIStlmxI 160 C 1 ❑Steel XXPli sek ❑Slainlome Steel ❑Other <br /> Creut Sed IXprh 100 ❑Near Cemrn"W A Aug/JJOgOI w/rrJ ❑SendCo.,Cel vmre <br /> Amix/)gel we ' <br /> IX Herten. colitis) ❑MenuNemm Spey%solids_% N&r,c_aA&jOD.QUjCk_OLMA 01Spew on File 13 Simon Svbmined <br /> Great PHcemeMlHelhod (]Pumped ❑Fra Fall 001hp ❑Rperdare/Accelereaor(namq _ <br /> PEDESTAL 1.011,41 By 13 Driller Mmp cenear.. 0Other <br /> ❑Concrete Pildeahl 01.1ovs: Width l Lcnp fl 'Duck in 0ChNi Boa OStove Pipe <br /> PUMP ❑Submersible ❑Turbine 00der HP Pump Ste 0 StaMi.S W.kr Lc,.l A <br /> WELL DEFIRUMOn 0Olpen Bottom ❑Gravel Pack ❑Utlwaed 0OIhei _ <br /> Well Dbrnctio in Taul Depth R Dep11,10Weap D 0Cevlagrobe Perfantttl from flm_R <br /> Seri Mewild O Nnt Curcnt(941bbug/3-)Ogdlwrr/ ❑SUMtcetent tuck eRe 17 gel wap 08rntom¢Pelletier <br /> ❑Bentoniin(20%rouse) C3M..Im, Nr Spa%avlida_% Name OSpcwon Fik OSpew Submitted <br /> r Placement Method 0 Pumped 0 Free Fell 0 Other - <br /> ❑Cmnplm with Mushroom Cep fl below grade ❑Complain b Exiting Surfeca Pad <br /> 1 HEREBY CERTIFY THAT 1 HAVE 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 CERTPY 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 /> Beer WORKERSCOMPENSATON LAWS. <br /> MINIMUM 24 HOUR ADVANCE NO B' ED -� <br /> sKavgD e.D� I SUPERV DATE 9-12-03 <br /> her, <br /> e <br /> 47 <br /> r <br /> 0 <br /> r � <br /> c <br /> IGI 1 e H M <br /> r NV RO s <br /> / D ARTMENT N1. <br /> Nee AMUCadon ACcepled By j 'Iron S e� Ata Emph,mlIDgQ <br /> Grout:.'perdu.By Date lt <br /> ❑ SPECIAL Well Perel <br /> Fump lmpraivn By Date ❑ WAIVER Received <br /> Dwwctiun Inapsdm BY Dene Constructed Well Depth R <br /> Lee COMMENTS ✓ <br /> PE I SC Re'el'ed Cha<WI wmsRM Date erniV Inv0xA9 Well lllq <br /> Cade. lata a RtmiHed Service R IwIR <br /> / <br /> r <br /> EHD 4} -006 MASTER WATER WELLPERM- <br /> `LA2002 <br />