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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTYENVIRONMENTAL HEALTH DEPARTMENT 1858 EAST HAZELTON AvENUE-STOCKTON CA 95205-(209)498-'3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 920 Frewert Road Lathrop,CA 95330 on <br /> Joe ADDRESS CIW/ZIP > <br /> S.Manthey Road 191-260-22 31 Acres z <br /> CROSSSTREET APN PARCEL SIZE_LANG USE APPLICATION <br /> OWNER NAME Harvest Power 55� t f L Jat kc&LZ <br /> I PHONE ,- <br /> 6943 N Golden State Blvd. �/-,v IW,,d L X ,,r Fresno,CA 93722 <br /> OWNER ADDRESS I. /STATFRIP <br /> CONTRACTOR Cal Pac Drilling •�,1,1yer'1',111 vak3b•l�"CA 9S'bI PHONE 909-795-7500 CAS-.o�(�"S� ✓�Wr� <br /> V <br /> 91, v CONTRACTOR ADDRESS 526 W.Ave.L CITYISTATErziP Calimesa,CA 92320 <br /> `. �,d I <br /> SUBCONTRACTOR PHONE / r� 1t/6R <br /> NTRA <br /> D 1 SUBCOCTOR ADDRESS CITy/STATE2Y, <br /> 1P 44w-s <br /> 1 LICENSE )(C-57 G-61 Q09 Other NUMBER7602 EXPIRATION DATE 07/31/2017 <br /> 11, <br /> GEOGRAPHICAL INFORMATION: COOrdiDateMX Y TOWllehlp_ Range_ $BcllOn <br /> INTENDED USE DOmeStiOPnvate Irrigation/Agricultural Industrial KWaler.Qwslay annoying Soil Sampling/Characterization <br /> P-1 { Y r UdItTw Wafture Inw Name (�Y� DayaBeot. arraaor one <br /> unn )510-8874 <br /> / t uam�,em sem ow„�: er nen # u <br /> ar✓1( TYPE OF WORN XNew Well Replacement Well Well Alteration/Modification Omer <br /> r v 7(Monitoring Wells) 2 #of wells Soil Boring #olbohtgs s) Geotechnical #orborhlgs <br /> ( � WA Out-Ol-Service Well Out-Of-Service Well Renewal Cross-Connecfion Repair <br /> 1(!Y Z New Pump Pump Replacement Pump Repair Raise Well Casing <br /> Do F"#".f( I r WELL CONSTRUCTIM <br /> ..M i pp Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth�)S _ft Excavation 6 in diameter Open Bottom XGmvel Pack/Gravel Sae_S12ed in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter 2 in Thidmess/Gauge/ASTM Schad 40 Steel XPlastic Stainless Steel Other <br /> y uIr ,f Grout Seal Depth 10 it NOW Cement(94 to bag/5-10gal water) Sand Cement sack mixO gal water <br /> Ili b f XBentonite(20%solids) Other <br /> V.TvA Grout Placement Method Pumped XFree Fall Omer Retardant/Accelerator(name) <br /> rJa \l PEDESTAL Installed By [killer Pump Contractor Other <br /> ir� It Concrete Padestal Dlmenslons:Wdm_ft Length ftThick in Christy Box Stove Pipe <br /> S�.,El1 1 Pump Submersible Turbine Omer HP Pump Set ft Standing Water Level ft <br /> A) e 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> ,1`�, 6V) I MINIM M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TIMEPresident,ABI Engineering Consultants,Inc DATE 6/30/2016 <br /> CEI V E® <br /> SLEP 0 6 2096 <br /> IRONWENTAL HEALTH <br /> ERMIT/SERVICES <br /> ppYM <br /> REQ <br /> S�Q <br /> JON <br /> E1N� <br /> HF?LT O <br /> DEPARTMENT USE ONLY <br /> Application Accepted By d IID Dale 9 j Z / Area /�(tJ 17 Employee ID# /07ZL9'0 <br /> Grout Inspection By ti rsP. Date I9 SPECIAL Wall Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Baring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Race hed ChING Amount Permh/ <br /> Codes Info B Cash fitted Date Service Ra uest# Invoice# WeIIID# <br /> k 1 313 C 178. 121 67 <br /> EHOCiCe WELLFVMPPERMIT <br /> 4nN1i <br />