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Application Form 01 APPLICATION FOR INELLjPUMP PERMIT /.• . - } ) _ ( 1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ` 1 V P 0 BOA 388,413 N.SAN JOAQUIN ST,STOCKTON.CA 89201388 (2991461-3420 RON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED •'I' ICRSIPlets kI Trymaml Applic tfcnr is here 6y a" to the Sen Joaquin County for a Permit to construct and/or install the Mark described. This application is made In cahpt I'A6!iIIfh $en Joaquin County Development Title, Chapter 9-1115.1 end the SImelards of San Joequin County Public Health Services, Environmental Health Division. Job Address/or APHN 110 N. Filbert Street City Stockton Parte( Site/ApNAAPprox.. 1.0 acre Owner's Nene Del Monte Foods Address_ 2716 E. Miner Ave Stockton Phone 8209-466-2011 Contractor_ Gregg Drilling Address_ Pacheco- !•A. Lich 4R516s Phone N510-680-4442 Sub Contractor N/A Address_ N/A Lfc# N/A Phone #_N/e ? 'I TYPE OF WELL/PUMP: M NEN WELL 11 REPLACEMENT WELL D MONITORING WELL # N OTHER [1 DESTRUCTION D GIT-OF-SERVICE WELL D GEOPHYSICAL WELL M [T SOIL BORING N INSTALLATION D WELL SYSTEM REPAIR D CROSS-CONNECT REPAIR iI. IF VAPOR EXTRACTION WELL NSeebeloW 11 Hex [7 Repair N.P. DEP,TN PUMP SpET FT FIRST WAT,ERR LEVEL 1 2 boAbP4sF(yW/SP1 and SVE/SP2), each boring cont nAsl e{2�Air sJ ar�in w 1uV ell INTENDED USE TWE OF WELL CONSTRUCTION SPECIFICATIONS (Also see attached Dri�lang Spec kation) I 11 INDUSTRIAL 0 OPEN L PACKSand Pack TYPE OF CELL EXCAVATION 12" DIA. Of WELLCONSMUCTOR USI G 2" Itt l ` N DOMESTIC/PRIVATE 0 GRAVEL PACK/SIZFt,ppgtar TYPE Of CASING/STEEL/PVL2@Sch.40PVCA DIA. OF WELL USING 2" sllr5 ❑ PUBIIC/MUNICIPAL [I DRIVEN 2/12 DEPTH OF GROUT SEAL 60" SPECIFICATION 1I9g F�1e29/R rs 0 IRRIGATION/AG D OTHER GROUT SEAL INSTALLED BY G. Drilling GROUT BRAND NAMENeat cement/Bentonite I3 MONITORING GROUT SEAL PUMPED: N Yea D No CONCRETE PEDESTAL BY DRILLER: I1 Yea kJ No APPROX.DEPTN 90' LOCKING CHESTER BOX/STOVE PIPE Connected to tie atment system PROPOSED CORSTRUCTIONIDRILLING METHOD: MUD ROTARY_AIR ROTARY_AUGER x TABLE_OTHER '1st 20' sch. 40 Carbon (Hollow-stem) Steel for Sparging well Thereby certify that 1 have prepared this application and that Me Mark Will be dome In accordance with San Joequin Canty Ordinances, State Laws, and Rules and Regulations of the San Joaquin County. Nome owner or licensed agent's signature certifies the following: 111 certify that in the performance of the work for which this permit is issued, 1 shell not employ Persons subject to WORKMAN'S COMPENSATION Laws of California." Contrector'e hiring or subcontracting signature certifies the following: " I certify that in the performance of the work for which this permit is issued, 1 shall employ persons subject to WORKMAN'S COMPENSATION Laws of California." THE APPLICANT I MUST CALL E4 NOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT UOM 488 3423. Complete drawing at lower area provided. Signed X fel .G= ;;o;i TitleProject Manager Date 9/21/94 PLOT PLAN (Draw to Scale) Scale. IT " to 20- 1. 0'1. Names of streets or road& nearest to or bourdIN the property. use hoswage disposal stem or sy 4. . Location of & 2. Outline of the property, givi ne di moral me and Worth direction. Proposed of ho Lan of sumps disposal Y systems. 3. Dimensioned outlines and location of all existing and proposed 5. Location of wells within radius of 150 ft. on structures, including covered areas such as patios, driveways, the property or adjoining property. end walk.. - See Application Form A2 for Specs on NPI r a ill rte. I„ =[e iZ I TIS F=, }/ LL I DEPARTMENT USE ONLY Application Accepted BY Dete e'r>� ` _� ! �yy Area Grout Inspection By ?7' Date �y Pup Inspection By Date_ k Destruction Inspection By Data Laments: ACCOUNTING ONLY: AID# TACO PE WOES FEEIMTO AMOURT REMITTED CHECXNCASN I RECEIVED BY DATE PERMITISERYICE REQUEST RUMBER FINVOICE 3 S 1 101 3,mooA)) /r 7�-94 F