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L " <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 306 E.WEBER AVE.. STOCKTON CA 95702 (209)468-3470 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> V roBADDRRss 748. 5WALKER W/0 21 i .'. <br /> PARCEL S STOCK70N 45215 <br /> OWNER NAME HURB: KEENER ADDRESS 748 S. WALKER <br /> V. cyan n0CKTON 45215 exo^ 4fi6n5403 <br /> cONTRACrOR NOACK AES <br /> DDRS 45M E. FRE14ONT STREET _ <br /> L a �TYSTOUTON, CA 45215 _ PEON'. 948-8817 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X_ Y_TOWNSHIP_ RANGE_SECTION <br /> TYPE OF WELL: O NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# OOTHER <br /> INSTALLATION: CO WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR O VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: O NEW GREPAIR HP. DEPTH PUMPSEr FT. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECTIDCALk OSOR.BORING ❑DESTRUCTION: <br /> INTENDED USE TYPE.OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELLEXCAVATIONDIA CONDUCTORCASINGDIA_ <br /> 11 DOMESTIC PRIVATE ❑GRAVEL PACE/SIZE WELLCASINGTYPE WELLCASINGDIA <br /> ❑PIIBLICJMUNICIPAL O DRIVEN GROUT SEAL OBP7H SPECTEICA170N <br /> O IRRIGATIOWAG OTHER GROUT BRAND NAME <br /> - <br /> 0 MONITORING 24 HRNOTICEOUT SEAL PUMPED: ❑YES ONO <br /> L <br /> ❑CHRISTY Box ❑STOVE Pin REQUESTE[--)CONCRETEPEDESTALBYDRH.LER: ❑YES ONO <br /> APPP=11.ATE WELL D FOR ALL CC;; <br /> PROPOSED CONSTRUCTIONIDRD.LING METHOD: MUD ROTARYIO AIR ROTARY_AUGER_CABLE_OTHER_ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THIN WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY O IAN S/T/A/T/E�LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: <br /> i 1 E; RETAPL SA DATE: 10/3/u0 PAYM€PIT <br /> J <br /> L Pi <br /> L <br /> L <br /> L <br /> LCEPMTMENT CSE NLY <br /> Applic w Acceprc BY m Asea <br /> G.t hsps .BY Due P-TImpm BY Dm B <br /> LDe=don Inspection BY Due <br /> COMMENTS: <br /> L PE Sc AMOUNT CHEC RECPIVED DATE PERMIT/SERVICE REQUEST M WELL JIM <br /> CODES INFO REMITTED ASH BY <br /> 4� o� I v� a ca <br /> L <br />