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WELLMUMP PERMIT <br /> A -owl��t <br /> SAN JOAQUIN COUNTY PUBLIC 1i1rA1.111 SIsRViCES E!vVIRONNIENTA�146R-yZprvIS1U <br /> V 304 E.WEBER AVE,THIRD FLOOR S-MC�N CA() (2 <br /> NON-RFFUNDABLE PERMIT PIRF:S I YEAR FROM DATE ISSUED <br /> �` dell — <br /> LEO—� =� PARCEL SfLE�� 5 <br /> rt4 --ADDRESS�� ��� y &� T " C-57 LICENSE#40L��-E UATTOWNSIIIP-- RANGE_— SECTIONGEOMATION: COORDINATFS X�-- Y-— ❑OTHER_ -- <br /> TYPE OF WELL: KNEW WELL [3REPLACEMENT WELL 13 MONTiCIRCdG WELL#,— - <br /> INSTALLATION: ❑ww.SYSTEM REPAIR ❑CROSS.('ONNIiCT REPAIR ❑VAPOR EXTRACTION FIRST WATER LEVEL — --- <br /> DEPTH PUMP SF•T�— <br /> TYPE OF PUMP: O NEW ❑REPAIR H.P.__--- ❑DESTRUCTION:- <br /> ❑OUT-0F SERVICE WELL ❑GEOI ECHNIC'AL#_--- ❑SOIL IIORING— <br /> OrIS7'R CTl^y 1CTA__1015 <br /> 'TYPE UF'WEI.I � <br /> Itr'Tmp USE f- CONDUCTOR CASING DIA-- <br /> 0 ❑OPEN BOTTOM WELL EXCAVATION DIA^ - <br /> INDUSTRIAL WELL CASING DIA -- <br /> RAVEL PACK/S17.1r—.- WELL CASING"TYPE. �— <br /> ❑DOMESTIC PRIVATE �� — _— <br /> GROUT SEAL DEPTII� _ SPEC[fICATION <br /> UBLIC/MUNICIPAL ❑DRIVEN 1q`241 <br /> 01 Y,I HF.H GAMUT1120r,4 ND NAMEky <br /> D IRRIGATION/AG /�•'� W (�� -0I , Y� G� E� ❑NO <br /> GROUT SEAL PUMPED: <br /> ❑MONITORING <br /> CONCRETE PEDESTAL BY DRR.LEK ❑YES NO <br /> 0 CHRISTY BOX ❑STOVG PIPE <br /> APPROXIMATE WELL DEPI'li ---` <br /> v'11IEH <br /> PROPOSED CONSTRUCTK]N/DRILLING METHOD: MUD ROTARY_— <br /> .AIR ROTARY—AUGER I HAVE __-CABLE.-- <br /> ,LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT' <br /> JOAQUIN COUNTY ORDINANCES,S. 'T PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DUNE IN ACCORDANCE WTTII SAN <br /> 1 HEREBYCERTIFY TIIA <br /> AND ACTIVE WITH THE CALIFORNIA COIV"1"RAC:TOR.S ST U�iy(ip�EhS Al'LON LAWS AND <br /> THAT I AM 1N CUAIPI, WITH ALL WORKMAN'S <br /> MINIM11M 24 HOUR ADVANCE NOTICE RL'QUIREI�FOR INSPECTIONS <br /> SIGNFD <br /> t L ► �l G�/��i�,�—— ——TITLE-�M �— -- <br /> _ <br /> - -�- <br /> ti _ <br /> . _ Q <br /> -4 <br /> l/ DEP ''MEDT USE ONLYk7-1 <br /> p Q <br /> j Application Accepted By— <br /> rII - Area <br /> Uate_1_: <br /> i Z _EMPiD# <br /> i Grout Inspection By Date _Pump Inspected By Date <br /> Date__ <br /> I truftion Inspection By <br /> MAfor.ENTS: Ell #1 Al -M�e t S�fF �I-a�t a 6 W��� n rd s �h 5�, 4-A vin <br /> i u n {I �SDF <br /> PF SC AMOUNT CHECK RECEIVED DATE PERMIT/SERVICE REQUEST# INVOICE# WELL Ill# <br /> CODES INFO REM D SH BY <br /> 3 3 12096 .3067 S" a <br /> s r <br />