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WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)469-3420 <br /> i <br /> NON-REFUNDABLE PERMIT L19UU I YEAR FROM DATE ISSUED 732YO— <br /> 7 JOB ADDRESS 5340 East Main Street AM � a' <br /> c�rm_ Stockton �E ITCA 95215 ----PARCEL <br /> OWNP.RNAME John Croce ADDRESS 5390 East Maia Street <br /> RSIr/L� Stockton, CA 95215 PHONE 209-462-3846 <br /> CONTRACTS Clark Well, Inc. ADDRESS 2024 East Charter Way QT <br /> crrymp Stockton, CA 95205 PHONE 209 462-7676 c-57Lxx sE.R371560 EXPDATED4/04 '-P <br /> O <br /> GEOGRAPHICAL INFORMATION: COORDINATES X_ Y_TOWNSHIP_ RANGE_SECTION m <br /> TYPE OF WELL: ❑ NEW WELL ❑ REPIgCEMENf WELL ❑ MONITORING WELLM 13 OTHER y <br /> INSTALLATION. 19 WELL SYSTEM REPAIR ❑CROSS-CONNPITREPAIR ❑VAPOR EXTRACTION WELLR } <br /> TYPE OF PUMP: KNEW ❑REPAIR H.F. 1 .5 DEPTH PUMPSET 130 ET. FIRST WATER LEVEL 62' <br /> O OUT.OF-SERVICE WELL ❑GEOTECHNICAL# OSOILBORING ❑DESTRUCTION: <br /> O1UNDED USE TYPE OF WELL CONSTEUCTIONSPECDTCA1110 <br /> C3 INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA_ <br /> RDOMFSTICPRIVATE ❑GRAVEL PACKISI2£_ WELL CASING TYPP.yS�„ WELL CASING DIA 6" "7 <br /> O PUBLICIMUNICIPAL 0DRIVI9N GROUTSEALDEPTH SPECIFICATION G <br /> n <br /> i ❑IRRIGATpN/AG OTHER GROUT BRAND NAME .r <br /> •MONITORING GROUT SEAL PUMPED: OYES ONO d <br /> O CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES O NO Z <br /> APPROXIMATE WELLDEFIH 190' <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUDROTARY_AIR ROTARY AUGER_CABLE_MER <br /> — <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORE WILL BE DONE IN ACCORDANCE WTTII SAN <br /> JOAQTIIN COUNTY OADINANCFS,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br /> ANDA WITH THE CALwoRN1A CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORTGMANB <br /> COMPENSATION LAWS <br /> IM 4 HO Ajt DVANCE NOTICE,REQUIRED FOR INSPECTIONS <br /> -9 1SIGNED �� Trn.E Sec-Tres —DATE-24//_13fl-0_3 <br /> lilq <br /> R% I ULAN <br /> OL <br /> Wp E <br /> a <br /> DEPARTMENT USE ONLY2 ''11 �Q��.. <br /> Application A¢WmdBY—�'�' Dam -3 --3—.J ,a BMflDY �449- <br /> Gmm Insp cum By Dam Pump InspecRM <br /> O caw.Wpeu0m By Dam <br /> COMMENTS: <br /> PB SC AMOUNT EC RECEIVED DATE PE.RMNISERVICE REQUEST# INVOICE WILL DR <br /> CODES INFO REMITTED BY <br /> Lf 380 USC SC b -2,� till <br />