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WELL / PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPMENT 304 E WEBER A}iF "°FL-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT LEL 209 953-7697 FOR INSPECTIONS Lf :zIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 11396 N. HIWAY 99 cIT1121P LORI, CA. 95240 CROSSSTREET MORSE RD. y v APN PARCEL SIZE OWNER NAME TNT TRUCKING �� I' j�' PHONE (209) 931-6000 y 5 OWNER ADDRESS 11396 N. HIWAY 99 . CITYISTATEIZtP LODI, CA.' 95240 CONTRACTOR NOACK PHONE (209) 948-8817 CONTRACTOR ADDRESS 4500 E. FREMONT ST. CITY/STATEIZIP STOCKTON, CA. 952(1/5 SUBCONTRACTOR PHONE__ SUBCONTRACTOR ADDRESS CITY/STATE/ZIP U O LICENSE IXC-57 ❑C-61 ❑D-09 ❑Other NUMBER 504513EXPIRATION DATE Cr.00.ttAPIHCAI.INrartMA•ITON: Coordinates X Y I Townslllp Range Section INTENDED USE ❑Duntestic/1'riVale ❑Irrigation/Agricultural ❑Industrial ❑Water Quality Moniloring ❑Soil Sampling/Characterization ❑Public Water Sy}�stem If different from i Wiicr. mer Sysicin Norm Contarl Name or Pbone Number TYPE OF WORK ❑New Well ❑Replacement Well 0 Well Alteration/Modification ❑Test Hole ❑Other ❑Monitoring Well(s) numbrr0[WCus 13 Soil Boring(s) number of borings 13 Geotechnical numberorborings ❑(Well Destruction ❑Out-OF-Service Well ❑Out-Of-Service Well Renewal ❑New Pum ❑Pump Replacement ❑Pump Repair ❑Cross-Connection Repair WELL CONSTRUCTION Drilling Method ❑Mud Rotary ❑Air Rotary ❑Auger ❑Cable Tool ❑Push Point O Other Proposed Well Depth I'll Excavation in diameter ❑Open Bottom ❑Gravel Pack/Gravel Size in diameter ❑Conductor Casing in diameter / Conductor Casing Depth li Well Casing Diameter in Thickaess/Gauge/ASTM Schcd ❑Steel ❑Plastic ❑Stainless Sleet O Other Grout Seal Depth Il ❑Neat Cement(941h hug/5-10 brd waled ❑Sand Cement vack rnix 17 gat water ❑Bentonite(20%solids) ❑Manufacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted Grout Placement Method ❑Pumped ❑f=ree Fall ❑Other ❑Retardant/Accelerator(name) PEDESTAL Installed By ❑Driller ❑Pump Contractor ❑Other ❑Concrete Pedestal Dimensions: Width R Length it Thick in ❑Christy Box ❑Stove Pipe PUMP ❑Submersible ❑Turbine 0 Other�- lip_ Pump Set 11 Standing Water Level li WILL DESTRUCTION ❑Open Ilullun1 ❑Gravci Pack ❑1Jncvtsed Q Other Well Diameter_6—ill "Tidal Depth 9]� 11 Dcpth to Water 70 li ❑Casing to tic Perloruled front 11 to Il Scaling Material ❑Neat Cement(94 11?hrrb/5-10&d tvurct) tX Sand Cementcock ages I7 gal water 11 Bentonite Pellets ❑Bentonite(20%solids) ❑Manufacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted Placement Method ❑Pumped W Free Fall ❑Other ❑Complete with Mushroom Cap ft below grade ❑Complete to Existing Surface Pad 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. I ALSO CERTI#Y THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS slcNeD « TITLE RETAIL SALES 11-12-02 DATE G S ry 4,K AA .� .,/ Ir - Wit ja DEPARTMENT USE ONLY q "^ �APPlicatrtrt-Aecepti flyvW:,• �i mate---1-1 - ,•-A'rca, ��=- irtuptoyee'IDIf' i Grout Inspection By Date ❑ SPECIAL Well Permit Pump Inspection By Date / ❑ WAIVER Received Destruction Inspection D� _ a- Dale �Constructed Well Depth rt COMMENTS 74!5:- 7�/n?%77�.9 f uSll�J 'q? }��x_..I�_� lr/ ��elr /� � �✓•?- PE Sc Arttouot Checkt! Received PcrmiU Dale Codes Into Remilted ns t liv Service Request H invoice ti Well IDIY 003 1 U1 ,I A, EHD 4302-006 MASTER WATER WELL PERMIT 97P-00Y