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V111A CAA <br /> • 18410 WELL/PtJMP PERMIT <br /> .H JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue.STOCKTON CA 95205-6232-(?09)468-34120' <br /> JN-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> m <br /> e ADDRESS 7735 S T RT 99 w- FRONT RD- CIrY/ZIP STOCKTON 95206 <br /> 1. <br /> n <br /> .OSS STREET (QANTAS T.N_ APN177-26-014 PARCELSIZE304.411NO USE APPLICATION# rn <br /> A <br /> 9NERNAME MORA]DA PRODUCE CO. PHOPIE546-0426 y, <br /> yNERADDRESS 5,0Q N ,jArX TONE. RD_ CITY/STATE21P STKN CA 95215 <br /> ,NTRACTOR Delta Pump-GTnr'KTnN ARMATURP R MOTOR WORKS 1aQ._209-466-9625 _ <br /> tNTRACTORADORES3 646 S. California Street CITY/STATEZIP Stockton, CA 95203 <br /> BCONTRAOTOR PHONE <br /> 13CONTRACTOR ADDRESS CITYISTATE/ZIP <br /> TENSE 0 C-57 xC-61 0 D-09 0 Other NUMBER 724778 EXPIRATIONDATE 08/0 <br /> .00RAPHICAL INFORMATION: Coordinates X Y Township_ RangO Section_ <br /> ,ENDED Use 0 Oomestic/Private 0 Irrigatlon/Agricultural ❑Industrial 0 Water Quality Monitoring D Soil Sampling/Characterization <br /> 0 Public Water System <br /> It different from Owner: Water SySterl NaMe contaCt NaMO or FhOne NUMDer <br /> PE OF WORK 0 New Well ❑Replacement Well 0 Well Alteratlon/Modlficatlon 0 Other <br /> 0 Monitoring Weli(s) #of wells ❑Soil Borings) 0 of borings 0 Geotechnical #or borings <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal D Cross-Connection Repair <br /> 0 New Pump ❑Pump Replacement MWump Repair 0 Raise Well Casin <br /> L CONSTRUCTION <br /> illing Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push Point ❑ Other <br /> oposod Well Depth ft Excavation In diameter ❑Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing In diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_In Thickness/Gauge/ASTM Sched D Steel 0 Plastic ❑Stainless Steel D Other <br /> Grout Seal Depth ft 0 Neat Cement(941b bag/6-10 gal wafer) 0 Sand Cement seclr mW7 gal water <br /> 0 Bentonite(20%solids) 0 Other <br /> -out Placement Method 0 Pumped O Free Fall ❑Other 0 Retardant/Accelerator(name) <br /> :DESTAL Installed By 0 Driller ❑Pump Contractor 0 Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length It Thick In ❑Christy Box D Stove Pipe <br /> !MP 0 Submersible yt•feurbine O Other HP F 0 Pump Set—J-4-0_ft Standing WE>,ter Lovel_ _ft <br /> iEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN AC60kDANCE WITH SAN <br /> )AQUIN COUNTY ORDINANCES,'STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> JRRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT.I AM IN COMPLIANCE WITH ALL <br /> ORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICEREQUIRED FOR INSPECTIONS <br /> GNED ^ - -� "^"�-�-•�� TITLE CEO DAT/21/2016 <br /> OV <br /> PUMP/WELL IS Iocatod nsdelM enclosure <br /> 1VE <br /> n<.r to ouantaz In.Ptl �d z E <br /> : D <br /> . i 3 2016 <br /> r, <br /> 5 E MTAL HEALTH <br /> 4MACHAD UMP 'ERWCES <br /> 1, t <br /> 6 : pqY <br /> 'All <br /> �D <br /> �3? <br /> R <br /> D EFP RTMENT USE NLY n <br /> Application Accepted By Date P.rea jaq Employee ID#'r: D <br /> Grout Inspection By a Date SPECIAL Well Permit <br /> Pump Inspection By_(�+r 5 i1 t n)P Datea= WAIVER R@COIVCd az <br /> Soil Boring Inspection By Date Constructod__Wpll Depth, ft <br /> OMMENTS �.f7�i77�S L�C�k" �LCrIyG=l �oYlr�Fr�il31— J� � �� i7li <br /> PE SC Received Amount Date Permit/ Invoice# WoIIID# <br /> Codes Info B ash Remitted Service Request# <br /> ti 41162 a767S 110 &F-0075-ON WpoasglLi <br /> 'D 4y'M <br /> -0106 WELL/PUMP PERMIT <br /> ) <br /> J <br />