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WELL/PUMP PERMII1_./ <br /> �nN SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> p 11 vv 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 <br /> U� NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED t <br /> JOB ADDRESS 10100 WEST L INNE ROAD fP(j/wP_ <br /> PARCELSIZE/APN CITY/ZIP TRACY, CA 95376 <br /> OWNER NAME AMERON PIPE CO ADDRESS 10100 WEST LINNE ROAD <br /> CITY/ZIP TRACY, CA 95376 PHONE(209) 836-5050 <br /> CONTRACTOR NOACK, ADDRESS 4500 E. FREMONT ST <br /> CITY/ZIP STOC K.TON, CA 95?_.15 PHONE (209) 9488817 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br /> TYPE OF WELL: ❑ NEW WELL 13REPLACEMENT WELL ❑ MONITORING WELL# 13OTHER <br /> INSTALLATION: 6 WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: El NEW 'D REPAIR H.P. 40 DEPTH PUMP SET 16 0 FT. FIRST WATER LEVEL 52 <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA <br /> ❑DOMESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASING TYPE WELL CASING DIA <br /> ❑PUBLICIMUNICIPAL ❑DRIVEN GROUT SEAL DEPTH SPECIFICATION <br /> - <br /> 00 IRRIGATIONIAG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROUT SEAL PUMPED: 0 YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES ❑NO <br /> 222" <br /> APPROXIMATE WELL DEPTH <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED; DICK TaYLOR . <br /> TITLE: RETAIL. SALES DATE; 4-21-00 <br /> C <br /> t <br /> K <br /> Al <br /> 20 <br /> - ^ y1 <br /> AMv- <br /> { <br /> 14 t <br /> �! <br /> DEPA MEN SE ONLY <br /> Application Accepted By c Date Area A19 <br /> Grout Inspection By Date Pump Inspected By Date=„--6 <br /> Destruction Inspection By Dale <br /> COMMENTS: <br /> PE SC AMOUNT CHECK# RECEIVED DATE PERMITISERVICE REQUEST# WELL ID# <br /> CODES INFO REMI BY <br />