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i <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY,PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIO?4 <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)468-3420 ? "^ <br /> LL <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 20 91 3 E. State R t. 12 t*L 15 APNr,2 3—1 1&-O- — <br /> CrryresP ClemeintS, Ca 95227 PARCEL SIZE 400 /�d. <br /> OWINERNAMEEdward Craig Family Um&ts P. O. Box 117, .Clements Ca <br /> CITY/ZIP Clements, Ca 95227 PHONE 209-887-3554 <br /> CONTRACTORPuryiance, Drillers, Inc. ADDRESS P. O. Box 64 <br /> cITY/ZIP Linden, Ca 95236 `PHONE 209-887-3554 C-57 LICENSE# 337923 EXP DATE7/03 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br /> TYPE OF WELL: X1 NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WE '# <br /> TYPE OF PUMP: ZI NEW ❑REPAIR H.P. 5 DEPTH 'PUMP SET fiT. FIRST WATER LEV <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOI.BORING ❑DESTRUCTION: <br /> INTENDED USE TYPE QF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL 1 OPEN BOTTOM WELL EXCAVATION DIA 14 3/dONDUCTOR CASING DIA <br /> IkDOMESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASING TYPE—s tell WELL CASING DIA 8 5/8 <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUT SEAL DEPTH -2-�Qi GSPECIFICATION . 15 6 <br /> ❑IRRIGATION/AG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROUT SEAL PUMPED: OYES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: 8I YES ❑NO <br /> APPROXIMATE WELLDEP l4 2 �S <br /> PROPOSED CONSTRUCTION/DRILLING METHOD:'MUD ROTARY x AIR ROTARY—AUGER—CABLE— OTHER <br /> — <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE HONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY 657 LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSATION LAWS. <br /> N� MSM ;a HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> i SIGNE .- T ECorporate Secretary DATE 9/11 /01 <br /> o .. <br /> `. I <br /> 4� T ; <br /> r <br /> ,rJ�i'i�� cRG <br /> i <br /> DEPARTMENT USE <br /> -- E ONL�hlA Application Accepted BY - aCk Date f Area Z - EMPM# <br /> F <br /> t Grout Inspection BYDa-�fte Pump Inspected By Date <br /> Destruction Inspection By ate <br /> COMMENTS: <br /> PE SC AMOUNT CHECW RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# WELL ID# <br /> CODES INFO REMITTED BY <br /> �t3F� DS 5D 3 1 <br />